I 

111TH CONGRESS 

2D SESSION H. R. 6528 

To provide for improvement of field emergency medical services, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2010 

Mr. WALZ (for himself and Mrs. MYRICK) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committee on Ways and Means, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To provide for improvement of field emergency medical 

services, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Field EMS Quality, Innovation, and Cost Effectiveness 

6 Improvements Act of 2010’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 


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Sec. 3. Definitions. 

Sec. 4. Recognition of NHTSA as primary Federal agency for field EMS. 

Sec. 5. Field EMS Excellence, Quality, Universal Access, Innovation and Preparedness. 

Sec. 6. Field EMS System Performance, Integration and Accountability. 

Sec. 7. Field EMS quality. 

Sec. 8. Field EMS education grants. 

Sec. 9. Evaluating innovative models for access and delivery of field EMS for 

patients. 

Sec. 10. Enhancing research in field EMS. 

Sec. 11. National Emergency Medical Services Advisory Council. 

Sec. 12. Emergency care coordination. 

Sec. 13. Emergency Medical Services Trust Fund. 

Sec. 14. Authorization of appropriations. 

1 SEC. 2. FINDINGS. 

2 The Congress finds the following: 

3 (1) All persons throughout the country should 

4 have access to and receive high-quality emergency 

5 medical care as part of a coordinated emergency 

6 medical services system. 

7 (2) Properly functioning emergency medical 

8 services (EMS) systems, 24 hours per day, 7 days 

9 per week, are essential to ensure access to emer10 gency medical care and transport for all patients 

11 with emergency medical conditions. Such coordi12 nated EMS systems are also necessary for response 

13 to catastrophic incidents. 

14 (3) Ensuring high-quality and cost-effective 

15 EMS systems requires readiness, preparedness, med16 ical direction, oversight, and innovation throughout 

17 the continuum of emergency medical care through 

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1 ration and sufficient resources for EMS agencies 

2 and providers. 

3 (4) At the Federal level, EMS responsibilities 

4 and resources of several Federal agencies consistent 

5 with their expertise and authority must emphasize 

6 the critical importance of Federal agency collabora7 tion and coordination for all emergency medical serv8 ices. 

9 (5) At the State and local level, EMS systems 

10 and agencies require the coordination and improved 

11 capabilities of multiple and diverse stakeholders. 

12 (6) Emergency medical services encompass the 

13 provision of care provided to patients with emer14 gency medical conditions throughout the continuum, 

15 including care provided in the field, hospital, and re16 habilitation settings. 

17 (7) Field EMS comprises essential emergency 

18 medical services, including medical care or medical 

19 transport provided to patients prior to or outside 

20 medical facilities and other clinical settings. The pri21 mary purpose of field emergency medical services is 

22 to ensure that emergency medical patients receive 

23 the right care at the right place in the right amount 

24 of time. 


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1 (8) Coordinated and high-quality field EMS is 

2 essential to the Nation’s security. Field EMS is an 

3 essential public service provided by governmental 

4 and nongovernmental agencies and practitioners 24 

5 hours a day, 7 days a week, and during catastrophic 

6 incidents. To ensure disaster and all-hazards pre7 paredness for EMS operations as part of the Na8 tion’s comprehensive disaster preparedness, Federal 

9 funding for preparedness activities, including cata10 strophic training and drills, must be provided to gov11 ernmental and nongovernmental EMS agencies so as 

12 to ensure a greater capability within each of these 

13 areas. 

14 (9) Numerous recommendations from several 

15 significant national reports and documents have 

16 demonstrated the need in multiple areas for substan17 tial improvement for emergency medical services pro18 vided in the field, including recommendations in the 

19 EMS Agenda for the Future, the Institute of Medi20 cine report ‘‘The Future of Emergency Care in the 

21 United Health System’’, and the National EMS 

22 Education Agenda for the Future: A Systems Ap23 proach and recommendations by the National EMS 

24 Workforce Injury and Illness Surveillance Program, 

25 the Department of Transportation’s National EMS 


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1 Advisory Council (NEMSAC), and the Federal 

2 Interagency Committee on Emergency Medical Serv3 ices (FICEMS). 

4 (10) To substantially improve field EMS ad5 vancements must be made in several essential areas 

6 including in readiness, innovation, preparedness, 

7 education and workforce development, safety, financ8 ing, quality, standards, and research. 

9 (11) The recognition of a primary Federal 

10 agency specifically for field EMS is necessary to pro11 vide a more streamlined, cost-efficient, and com12 prehensive approach for field EMS as well as pro13 vide a focal point for practitioners and agencies to 

14 interface with the Federal Government. 

15 (12) The long-standing role and capability of 

16 the National Highway Traffic Safety Administration 

17 (NHTSA) to promote the development of field EMS 

18 should be enhanced to serve in a federally recognized 

19 leadership role for field EMS, and enable NHTSA to 

20 serve as a full and equal partner with other Federal 

21 agencies that oversee other aspects of the EMS sys22 tem and national preparedness and response. 

23 (13) The Emergency Care Coordinating Center 

24 (ECCC) should be statutorily created to ensure its 

25 continued and essential leadership role in supporting 


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1 the Federal Government’s coordination of in-hospital 

2 emergency medical care activities, including by pro3 moting the regionalization of emergency medical 

4 care and promoting other programs and resources 

5 that improve the seamless delivery of the Nation’s 

6 daily emergency medical care and emergency behav7 ioral care. 

8 (14) The essential role of field EMS in disaster 

9 preparedness and response must be incorporated 

10 into the national preparedness and response strategy 

11 and implementation as provided and overseen by the 

12 Department of Homeland Security and the Depart13 ment of Health and Human Services pursuant to 

14 their respective jurisdictions. 

15 (15) The discretionary National EMS Advisory 

16 Council (NEMSAC) created by the Department of 

17 Transportation under the Federal Advisory Com18 mittee Act should be a statutorily established council 

19 that ensures non-Federal input and recommenda20 tions to NHTSA, FICEMS, and all Federal agencies 

21 involved with EMS. 

22 (16) FICEMS must continue in its essential 

23 role in coordinating the Federal activities related to 

24 the full spectrum of EMS. 


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1 SEC. 3. DEFINITIONS. 

2 In this Act: 

3 (1) The term ‘‘EMS’’ means emergency medical 

4 services. 

5 (2) The term ‘‘FICEMS’’ means the Federal 

6 Interagency Committee on Emergency Medical Serv7 ices. 

8 (3) The term ‘‘field EMS’’ means emergency 

9 medical services provided to patients (pursuant to 

10 transport by ground, air, or otherwise) prior to or 

11 outside a medical facility or other clinical setting. 

12 (4) The term ‘‘field EMS agency’’ means an or13 ganization providing field EMS, regardless of— 

14 (A) whether such organization is govern15 mental, nongovernmental, or volunteer; and 

16 (B) whether such organization provides 

17 field EMS by ground, air, or otherwise. 

18 (5) The term ‘‘emergency medical services’’ or 

19 ‘‘EMS’’ means emergency medical care and related 

20 services provided to patients at any point in the con21 tinuum of health care services, including emergency 

22 medical dispatch and medical care and related serv23 ices provided in the field, during transport, or in a 

24 medical facility or other clinical setting. 

25 (6) The term ‘‘field EMS patient care reports’’ 

26 means the information that a field EMS agency 


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1 typically creates regarding a patient’s medical condi2 tion and treatment in the course of providing emer3 gency medical services to that patient. 

4 (7) The term ‘‘NEMSAC’’ means the National 

5 Emergency Medical Services Advisory Council estab6 lished by section 12. 

7 (8) The term ‘‘NEMSIS’’ means the National 

8 EMS Information System. 

9 (9) The term ‘‘NHTSA’’ means the National 

10 Highway Traffic Safety Administration. 

11 (10) The term ‘‘State EMS Office’’ means an 

12 office designated by the State with primary responsi13 bility for oversight of the State’s EMS system, such 

14 as responsibility for oversight of EMS coordination, 

15 licensing or certifying EMS practitioners, and EMS 

16 system improvement. 

17 (11) The term ‘‘STEMI’’ means ST–Segment 

18 Elevation Myocardial Infarction. 

19 SEC. 4. RECOGNITION OF NHTSA AS PRIMARY FEDERAL 

20 AGENCY FOR FIELD EMS. 

21 (a) PRIMARY FEDERAL AGENCY FOR FIELD EMS.— 

22 NHTSA shall serve as the primary Federal agency for 

23 field EMS to provide enhanced Federal support for the 

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1 ical services that are accessible to patients throughout the 

2 United States and which ensure 24 hours a day, 7 days 

3 a week readiness, catastrophic preparedness, and con4 tinual innovation in quality and capability for the better5 ment of patients. In this capacity, the Administrator of 

6 NHTSA shall— 

7 (1) provide enhanced leadership for emergency 

8 medical services provided in the field; 

9 (2) work in partnership with the other Federal 

10 agencies involved with EMS in their respective lead11 ership roles in overseeing other aspects of the full 

12 spectrum of emergency medical services and pre13 paredness and response; and 

14 (3) work in collaboration with FICEMS, which 

15 coordinates all Federal EMS efforts, to ensure a 

16 seamless Federal approach to a coordinated emer17 gency medical services system across the continuum 

18 of emergency medical care. 

19 (b) COHESIVE NATIONAL FIELD EMS STRATEGY.— 

20 The Administrator of NHTSA shall, pursuant to this Act, 

21 develop and implement a cohesive national strategy to 

22 strengthen the development of field emergency medical 

23 services (EMS) at the Federal, State, and local levels. In 

24 establishing such a strategy, the Administrator shall— 


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1 (1) solicit and consider the recommendations of 

2 the NEMSAC as well as relevant stakeholders; 

3 (2) consult and collaborate with FICEMS to 

4 ensure consistency of such a field EMS strategy 

5 within the larger Federal strategy regarding all of 

6 emergency medical services and national prepared7 ness and response; 

8 (3) address issues related to EMS patient and 

9 practitioner safety, standardization of EMS practi10 tioner licensing and credentialing, field EMS oper11 ational improvements and integration of field EMS 

12 practitioners into the broader health care system in13 cluding— 

14 (A) promotion of the adoption by States of 

15 the education standards identified in the 

16 ‘‘Emergency Medical Services Education Agen17 da for the Future: A Systems Approach’’ and 

18 any revisions thereto, including the standardiza19 tion of licensing and credentialing of field EMS 

20 practitioners and standards of care, based on 

21 best practices and evidence-based medicine, in22 cluding by— 

23 (i) the identification of differences in 

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1 censure and credentialing requirements 

2 among the States; and 

3 (ii) the adoption by the States of na4 tional standards for such levels of care, 

5 scope of practice and licensure and 

6 credentialing requirements; 

7 (B) promotion of a culture of safety, in8 cluding— 

9 (i) the adoption of an anonymous 

10 error reporting system designed to identify 

11 systemic problems in field EMS patient 

12 and practitioner safety and ensure a single 

13 means of collecting and reporting relevant 

14 error data by field EMS agencies and 

15 States; 

16 (ii) the establishment of field EMS 

17 patient and practitioner safety goals and 

18 the specific means to improve field EMS 

19 practitioner and patient safety to achieve 

20 such goals; and 

21 (iii) the adoption of more uniform na22 tional ambulance vehicle safety and manu23 facturing standards; 


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1 (C) the integration and utilization of field 

2 EMS practitioners as part of the larger health 

3 care system including— 

4 (i) the potential utilization of field 

5 EMS practitioners for the provision of care 

6 to patients with non-emergent medical con7 ditions; and 

8 (ii) such other strategies to implement 

9 the recommendations provided by the Na10 tional Health Care Workforce Commission, 

11 pursuant to section 5101(d)(2) of the Pa12 tient Protection and Affordable Care Act 

13 (42 U.S.C. 294q(d)(2)); and 

14 (D) such other issues that the Adminis15 trator considers appropriate; 

16 (4) complete the development of such strategy 

17 not later than 18 months after the date of enact18 ment of this Act; 

19 (5) communicate such strategy to the relevant 

20 congressional committees of jurisdiction; 

21 (6) implement such strategy to the extent prac22 tical not later than 3 years after the date of enact23 ment of this Act; and 

24 (7) update such strategy not less than every 3 

25 years. 


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1 (c) STATUTORY CONSTRUCTION.—Nothing in this 

2 Act shall be construed to preempt any statutory authority 

3 otherwise provided for any other Federal agency. 

4 SEC. 5. FIELD EMS EXCELLENCE, QUALITY, UNIVERSAL AC5 CESS, INNOVATION AND PREPAREDNESS. 

6 (a) IN GENERAL.—The Administrator shall establish 

7 the EQUIP grant program— 

8 (1) to promote excellence in all aspects of the 

9 provision of field EMS by field EMS agencies; 

10 (2) to enhance the quality of emergency medical 

11 care provided to patients by field EMS practitioners 

12 through evidence-based, medically directed field 

13 emergency care; 

14 (3) to promote universal access to and avail15 ability of high-quality field EMS in all geographic lo16 cations of the Nation; 

17 (4) to spur innovation in the delivery of field 

18 EMS; and 

19 (5) to improve EMS agency preparedness for 

20 everyday and catastrophic emergency medical re21 sponse. 

22 (b) APPLICATION.— 

23 (1) IN GENERAL.—To be eligible to receive a 

24 grant under this section, an eligible entity shall sub25 mit an application to the Administrator in such form 


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1 and manner, that contains such agreements, assur2 ances, and information as the Administrator deter3 mines to be reasonably necessary to carry out this 

4 section. 

5 (2) SIMPLE FORM.—The Administrator shall 

6 ensure that grant application requirements are not 

7 unduly burdensome to smaller and volunteer field 

8 EMS agencies or other agencies with limited re9 sources. 

10 (c) USE OF FUNDS.—Grants may be used by eligible 

11 entities to— 

12 (1) sustain field EMS practitioners to ensure 

13 24 hours a day, 7 days a week readiness and pre14 paredness at the local level; 

15 (2) develop and implement initiatives related to 

16 delivery of medical services, including— 

17 (A) innovative clinical practices to improve 

18 the cost-effectiveness and quality of care deliv19 ered to emergency patients in the field that re20 sults in improved patient outcomes and cost 

21 savings to the health system, including for high 

22 prevalence emergency medical conditions such 

23 as sudden cardiac arrest, STEMI, stroke, and 

24 trauma; and 


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1 (B) delivery systems to improve patient 

2 outcomes, which may include implementing evi3 dence-based protocols, interventions, systems, 

4 and technologies to reduce clinically meaningful 

5 response times; 

6 (3) purchase and implement— 

7 (A) medical equipment and training for 

8 using such equipment; 

9 (B) communication systems to ensure 

10 seamless and interoperable communications 

11 with other first responders; and 

12 (C) information systems to comply with 

13 NEMSIS data collection and integrate field 

14 emergency care with electronic medical records; 

15 (4) participate in federally sponsored field EMS 

16 research; 

17 (5) establish or enhance comprehensive medical 

18 oversight and quality assurance programs that in19 clude the active participation by medical directors in 

20 field EMS medical direction and educational pro21 grams; and 

22 (6) such other uses as the Administrator may 

23 establish. 


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1 (d) ADMINISTRATION OF GRANTS.—In establishing 

2 and administering the EQUIP grant program, the Admin3 istrator— 

4 (1) shall establish a grant making process that 

5 includes— 

6 (A) prioritization for the awarding of 

7 grants to eligible entities and consideration of 

8 the factors in reviewing grant applications by 

9 eligible entities including— 

10 (i) demonstrated financial need for 

11 funding; 

12 (ii) utilization of public and private 

13 partnerships; 

14 (iii) enhanced access to high-quality 

15 field EMS in under served geographic 

16 areas; 

17 (iv) unique needs of volunteer and 

18 rural field EMS agencies; 

19 (v) distribution among a variety of ge20 ographic areas, including urban, suburban, 

21 and rural; 

22 (vi) distribution of funds among types 

23 of EMS agencies, including governmental, 

24 non-governmental and volunteer; 


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1 (vii) implementation of evidence-based 

2 interventions that improve quality of care, 

3 patient outcomes, efficiency, or cost effec4 tiveness; and 

5 (viii) such other factors as the Admin6 istrator considers necessary; 

7 (B) a peer reviewed process to recommend 

8 grant allocations in accordance with the 

9 prioritization established by the Administrator 

10 except that final award determinations shall be 

11 made by the Administrator; and 

12 (C) the provision of grant awards to eligi13 ble entities on an annual basis, except that the 

14 Administrator may reserve not more than 25 

15 percent of the available appropriations for 

16 multi-year grants and no grant award may ex17 ceed a 2-year period; 

18 (2) shall consult with and take into consider19 ation the recommendations of FICEMS, NEMSAC 

20 and relevant stakeholders; 

21 (3) shall ensure that funds used for cata22 strophic preparedness activities are consistent and 

23 aligned with Federal preparedness priorities; and 

24 (4) may contract with an independent, third25 party, nonprofit organization to administer the grant 


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1 program if the Administrator establishes conflict-of2 interest requirements as part of any such contrac3 tual relationship. 

4 (e) ELIGIBILITY.—Eligible grant recipients are field 

5 EMS agencies that— 

6 (1) are licensed by or otherwise authorized in 

7 the State in which they operate; and 

8 (2) have medical oversight and quality improve9 ment programs as defined by the Administrator. 

10 (f) ANNUAL REPORT.—The Administrator shall sub11 mit an annual report on the EQUIP grant program under 

12 this section to the Congress. 

13 SEC. 6. FIELD EMS SYSTEM PERFORMANCE, INTEGRATION 

14 AND ACCOUNTABILITY. 

15 (a) IN GENERAL.—The Administrator shall establish 

16 the SPIA grant program— 

17 (1) to improve field EMS system performance, 

18 integration and accountability; 

19 (2) to ensure preparedness for field EMS at the 

20 State and local levels; 

21 (3) to enhance physician medical oversight of 

22 field EMS systems; 

23 (4) to improve coordination between regional 

24 field EMS systems and integration of such regional 


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1 field EMS systems into the larger health care sys2 tem; 

3 (5) to enhance data collection and analysis to 

4 improve, on a continuing basis, the field EMS sys5 tem; and 

6 (6) to enhance standardization of national EMS 

7 certification of emergency medical technicians and 

8 paramedics. 

9 (b) USE OF FUNDS.—Grants may be used by eligible 

10 entities— 

11 (1) to enhance pandemic influenza and all haz12 ards EMS preparedness and coordination of medical 

13 first response; 

14 (2) to improve cross-border collaboration and 

15 planning among States; 

16 (3) to collect data with regard to— 

17 (A) NEMSIS; 

18 (B) field EMS education; 

19 (C) field EMS workforce; 

20 (D) cardiac events, including STEMI and 

21 sudden cardiac arrest; 

22 (E) stroke; 

23 (F) disasters, including injuries and ill24 nesses; 


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1 (G) ambulance diversion and patient park2 ing; 

3 (H) trauma (in a manner that is com4 plementary and not duplicative of other trauma 

5 data collection such as the National Trauma 

6 Data Bank); 

7 (I) data determined necessary by the State 

8 Office of EMS for oversight and coordination of 

9 the State field EMS system; and 

10 (J) any other such data that the Adminis11 trator specifies; 

12 (4) to implement and evaluate system-wide 

13 quality improvement initiatives, including medical di14 rection at the State, local, and regional levels; 

15 (5) to integrate field EMS with other health 

16 care services as part of a coordinated system of care 

17 provided to patients with emergency medical condi18 tions to help ensure the right patient receives the 

19 right care by the right crew in the right vehicle and 

20 at the right medical facility in the right amount of 

21 time, including by enhancing regional emergency 

22 medical dispatch; 

23 (6) to incorporate national EMS certification 

24 for all levels of emergency medical technicians and 

25 paramedics; 


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1 (7) to improve the State’s planning for ensuring 

2 a consistent, available EMS workforce; 

3 (8) to fund EMS regional and local oversight 

4 and planning organizations or develop regional sys5 tems of emergency medical care within the State to 

6 further enhance coordination and systemic develop7 ment throughout the State; and 

8 (9) for such other uses as the Administrator 

9 may establish. 

10 (c) ADMINISTRATION OF GRANTS.—In establishing 

11 and administering the SPIA grant program, the Adminis12 trator shall— 

13 (1) establish State EMS system performance 

14 standards to serve as guidance to States in improv15 ing their EMS systems and in applying for grants 

16 under this subsection. In establishing such stand17 ards, the Administrator shall— 

18 (A) take into the consideration the rec19 ommendations of FICEMS, NEMSAC, and rel20 evant stakeholders; 

21 (B) include national evidence-based guide22 lines; and 

23 (C) take into account the needs and re24 source limitations of volunteer, smaller agen25 cies, and agencies in rural areas; 


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1 (2) provide technical assistance to State EMS 

2 Offices in conducting comprehensive EMS planning 

3 with regard to evidence-based workforce and devel4 opment competencies for field EMS management; 

5 (3) allocate, within the available funds, SPIA 

6 grants to a maximum of one grant per applicant ac7 cording to a formula based on population and geo8 graphic area, as determined by the Administrator, 

9 for a period not to exceed 2 years; and 

10 (4) require that States allocate a portion of 

11 their grant funds to regional and local oversight and 

12 planning EMS organizations within the State for the 

13 purpose of field EMS system development, mainte14 nance and improvement of coordination among re15 gional organizations. 

16 (d) APPLICATION.—To be eligible to receive a grant 

17 under this section, an eligible entity shall submit an appli18 cation to the Administrators in such form and manner, 

19 that contains such agreements, assurances and informa20 tion as the Administrator determines to be reasonably nec21 essary to carry out this section. 

22 (e) ELIGIBILITY.—The eligible entities for a grant 

23 under this section are the State EMS Office in each of 

24 the several States, tribes, and territories. 


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1 (f) ANNUAL REPORT.—The Administrator shall sub2 mit an annual report on the SPIA grant program under 

3 this section to the Congress. 

4 SEC. 7. FIELD EMS QUALITY. 

5 (a) MEDICAL OVERSIGHT.— 

6 (1) IN GENERAL.—To improve medical over7 sight of field EMS and ensure continuity and ac8 countability for such medical oversight, the Adminis9 trator of NHTSA shall— 

10 (A) establish national guidelines for train11 ing, credentialing, and direction in connection 

12 with medical oversight; and 

13 (B) promote high-quality medical direction 

14 and maximization of participation and training 

15 by physicians in medical direction. 

16 (2) CONSIDERATIONS.—In establishing guide17 lines under paragraph (1)(A), the Administrator of 

18 NHTSA shall take into consideration— 

19 (A) nationally recognized guidelines; 

20 (B) relevant stakeholder input; and 

21 (C) the unique needs associated with the 

22 provision of field EMS in rural areas or by vol23 unteers. 

24 (3) FLEXIBILITY.—The guidelines established 

25 under paragraph (1)(A) shall ensure high-quality 


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1 training, credentialing, and direction in connection 

2 with medical oversight of field EMS at the State, re3 gional, and local levels while providing sufficient 

4 flexibility to account for historical and legitimate dif5 ferences in field EMS among States, regions, and lo6 calities. 

7 (4) REQUIRED USE OF GUIDELINES.—As a con8 dition on receipt of a grant under section 5 or 6, the 

9 Administrator of NHTSA shall require the grant re10 cipient to adopt and implement (to the extent appli11 cable) the guidelines established under paragraph 

12 (1)(A). 

13 (b) GAO STUDY AND REPORT.— 

14 (1) IN GENERAL.—The Comptroller General of 

15 the United States shall complete a study on— 

16 (A) medical and administrative liability 

17 issues that may impede— 

18 (i) medical direction provided by phy19 sicians directly regarding specific patients 

20 or medial oversight provided by physicians 

21 in establishing medical protocols, proce22 dures, and other activities related to the 

23 provision of emergency medical care in 

24 field EMS; or 


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1 (ii) the highest quality emergency 

2 medical care in field EMS provided by per3 sonnel other than physicians such as emer4 gency medical technicians and paramedics; 

5 (B) reimbursement for any component of 

6 medical oversight; and 

7 (C) such other issues as the Comptroller 

8 General deems appropriate relating to improv9 ing the quality and medical oversight of emer10 gency medical care in field EMS. 

11 (2) REPORT TO CONGRESS.—Not later than 18 

12 months after the date of the enactment of this Act, 

13 the Comptroller General shall complete the study 

14 under paragraph (1) and submit a report to the 

15 Congress on the results of such study, including any 

16 recommendations. 

17 (c) DATA COLLECTION AND EXCHANGE.— 

18 (1) NATIONAL EMS INFORMATION SYSTEM.— 

19 (A) IN GENERAL.—The Administrator of 

20 NHTSA may maintain, improve, and expand 

21 the National EMS Information System, includ22 ing the National EMS Database. 

23 (B) STANDARDIZATION.—In carrying out 

24 subparagraph (A), the Administrator of 

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1 porting of data on field EMS in a standardized 

2 manner. 

3 (C) AVAILABILITY OF DATA.—The Admin4 istrator of NHTSA shall ensure that informa5 tion in the National EMS Database (other than 

6 individually identifiable information) is available 

7 to Federal and State policymakers, EMS stake8 holders, and researchers. 

9 (D) TECHNICAL ASSISTANCE.—In carrying 

10 out subparagraph (A), the Administrator of 

11 NHTSA may provide technical assistance to 

12 State and local agencies, field EMS agencies, 

13 and other entities deemed appropriate by the 

14 Administrator to assist in the collection, anal15 ysis, and reporting of data. 

16 (2) REPORT ON DATA GAPS.— 

17 (A) IN GENERAL.—Not later than 12 

18 months after the date of the enactment of this 

19 Act, the Administrator of NHTSA, in consulta20 tion with the Secretary of Health and Human 

21 Services, shall submit to the Congress a report 

22 that— 

23 (i) identifies gaps in the collection of 

24 data related to the provision of field EMS; 

25 and 


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1 (ii) includes recommendations for im2 proving the collection, reporting, and anal3 ysis of such data. 

4 (B) RECOMMENDATIONS.—The rec5 ommendations required by subparagraph (A)(ii) 

6 shall— 

7 (i) take into consideration the rec8 ommendations of FICEMS and NEMSAC 

9 and relevant stakeholders; 

10 (ii) recommend methods for improving 

11 data collection and reporting and analysis 

12 without unduly burdening reporting enti13 ties and without duplicating existing data 

14 sources (such as data collected by the Na15 tional Trauma Data Bank); 

16 (iii) address the quality and avail17 ability of data related to the provision of 

18 field EMS and utilization of field EMS 

19 with respect to a variety of illnesses and 

20 injuries (in both the everyday provision of 

21 field EMS and catastrophic or disaster re22 sponse) including— 

23 (I) cardiac events such as chest 

24 pain, sudden cardiac arrest, and 

25 STEMI; 


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1 (II) stroke; 

2 (III) trauma; 

3 (IV) disaster and catastrophic in4 cidents, such as incidents related to 

5 terrorism or natural or manmade dis6 asters; and 

7 (V) ambulance diversion and pa8 tient parking; and 

9 (iv) include an analysis of the variety 

10 of services provided by field EMS agencies. 

11 (3) REPORT ON DATA INTEGRATION TO PRO12 MOTE QUALITY OF CARE.—Not later than 18 

13 months after the date of the enactment of this Act, 

14 the Secretary of Health and Human Services, acting 

15 through the head of the Office of the National Coor16 dinator for Health Information Technology, in col17 laboration with FICEMS and the Administrator of 

18 NHTSA as appropriate, and taking into consider19 ation input from relevant stakeholders, shall submit 

20 a report (including recommendations) on issues, im21 pediments, and potential solutions pertaining to the 

22 following objectives: 

23 (A) Incorporation of field EMS patient 

24 care reports into patient electronic health 

25 records, taking into consideration— 


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1 (i) the extent to which field EMS pa2 tient care reports are presently created in 

3 electronic format and the potential for ele4 ments of such reports to be incorporated 

5 into patient electronic health records; 

6 (ii) the data elements of field EMS 

7 patient care reports that would promote 

8 quality and efficiency of care if incor9 porated into patient electronic health 

10 records; 

11 (iii) potential modifications to the 

12 Medicare and Medicaid programs under ti13 tles XVIII and XIX, respectively, of the 

14 Social Security Act or other Federal health 

15 programs (including potential modifica16 tions to the HITECH Act (title XIII of di17 vision A of Public Law 111–5) including 

18 modifications to the entities included as el19 igible for incentive payments under section 

20 1848(o), 1853(l) (to the extent that such 

21 section 1848(o) is applied), or 1903(t) of 

22 the Social Security Act, criteria for cer23 tified EHR technology for purposes of 

24 such sections, and objectives and measures 

25 for determining meaningful use of such 


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1 technology for purposes of such sections) 

2 to provide appropriate reimbursement and 

3 financial incentives for EMS agencies— 

4 (I) to maintain field EMS patient 

5 care reports in a structured electronic 

6 format; and 

7 (II) to otherwise adopt and use 

8 electronic health records; and 

9 (iv) potential modifications to the 

10 HITECH Act to provide incentives to eligi11 ble hospitals under section 1886(n), 

12 1853(m) (to the extent that such section 

13 1886(n) is applied), or section 1814(l)(3) 

14 of the Social Security Act to incorporate 

15 appropriate data elements of field EMS 

16 patient care reports into patient electronic 

17 health records. 

18 (B) Incorporation of patient health infor19 mation created subsequent to the receipt of 

20 field EMS emergency care into NEMSIS, tak21 ing into consideration— 

22 (i) what types of medical information 

23 created subsequent to the receipt of field 

24 EMS emergency care (such as outcomes 

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1 sequent care and treatment) would, if in2 cluded in NEMSIS, be potentially useful in 

3 evaluating and improving the quality of 

4 EMS care; 

5 (ii) how best to integrate such infor6 mation into NEMSIS; 

7 (iii) potential modifications to the 

8 HITECH Act to require eligible hospitals, 

9 as defined in section 1886(n)(6)(B) of the 

10 Social Security Act, for purposes of incen11 tive payments under 1886(b)(3)(B)(ix) and 

12 1886(n) of such Act, to develop or report 

13 relevant data to NEMSIS or other appro14 priate State or private registries; and 

15 (iv) potential modifications to the 

16 Medicare and Medicaid programs under ti17 tles XVIII and XIX, respectively, of the 

18 Social Security Act or other Federal health 

19 programs to provide appropriate reim20 bursement and financial incentives for field 

21 EMS agencies to develop or report relevant 

22 data to NEMSIS or other appropriate 

23 State or private registries. 

24 (d) CLARIFICATION OF HIPAA.— 


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1 (1) EXCHANGE OF INFORMATION RELATED TO

2 THE TREATMENT OF PATIENTS.— 

3 (A) IN GENERAL.—Nothing in HIPAA pri4 vacy and security law (as defined in section 

5 3009(a)(2) of the Public Health Service Act (42 

6 U.S.C. 300jj–19(a)(2))) shall be construed as 

7 prohibiting the exchange of information between 

8 field EMS practitioners treating an individual 

9 and personnel of a hospital to which the indi10 vidual is transported for the purposes of relat11 ing information on the medical history, treat12 ment, care, and outcome of such individual (in13 cluding any health care personnel safety issues 

14 such as infectious disease). 

15 (B) GUIDELINES.—The Secretary of 

16 Health and Human Services shall establish 

17 guidelines for exchanges of information between 

18 field EMS practitioners treating an individual 

19 and personnel of a hospital to which the indi20 vidual is transported to protect the privacy of 

21 the individual while ensuring the ability of such 

22 EMS practitioners and hospital personnel to 

23 communicate effectively to further the con24 tinuity and quality of emergency medical care 

25 provided to such individual. 


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1 (2) NEMSIS DATA.—Nothing in HIPAA pri2 vacy and security law (as defined in section 

3 3009(a)(2) of the Public Health Service Act (42 

4 U.S.C. 300jj–19(a)(2))) shall be construed as pro5 hibiting— 

6 (A) a field EMS agency from submitting 

7 EMS data to the State EMS Office for the pur8 pose of quality improvement and data collection 

9 by the State for submission to NEMSIS; or 

10 (B) the State EMS Office from submitting 

11 aggregated non-individually identifiable EMS 

12 data to the National EMS Database maintained 

13 by NHTSA. 

14 SEC. 8. FIELD EMS EDUCATION GRANTS. 

15 (a) IN GENERAL.—For the purpose of promoting 

16 field EMS as a health profession and ensuring the avail17 ability, quality, and capability of field EMS educators, 

18 practitioners, and medical directors, the Secretary of 

19 Health and Human Services, acting through the Adminis20 trator of the Health Resources and Services Administra21 tion, may make grants to eligible entities for the develop22 ment, availability, and dissemination of field EMS edu23 cation programs and courses that improve the quality and 

24 capability of field EMS personnel. In carrying out this sec25 tion, the Secretary shall take into consideration input from 


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1 the Administrator of NHTSA, FICEMS, NEMSAC, the 

2 National Health Care Workforce Commission established 

3 under section 5101 of the Patient Protection and Afford4 able Care Act (42 U.S.C. 294q), and relevant stake5 holders. 

6 (b) ELIGIBILITY.—In this section, the term ‘‘eligible 

7 entity’’ means an educational organization, an educational 

8 institution, a professional association, and any other entity 

9 involved with the education of field EMS practitioners. 

10 (c) USE OF FUNDS.—The Secretary of Health and 

11 Human Services may award a grant to an eligible entity 

12 under paragraph (1) only if the entity agrees to use the 

13 grant to— 

14 (1) develop and implement education programs 

15 that— 

16 (A) train field EMS trainers and promote 

17 the adoption and implementation of the edu18 cation standards identified in the ‘‘Emergency 

19 Medical Services Education Agenda for the Fu20 ture: A Systems Approach’’ including any revi21 sions thereto; 

22 (B) bridge the gap in knowledge and skills 

23 in field EMS and among field EMS and other 

24 allied health professions to develop a larger 

25 cadre of educational instructors and build a 


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1 stronger and more flexible field EMS practi2 tioner corps; or 

3 (C) provide training and retraining pro4 grams to provide displaced workers the oppor5 tunity to enter a field EMS profession; 

6 (2) develop and implement educational courses 

7 pertaining to— 

8 (A) instructor courses; 

9 (B) provision of medical direction of field 

10 EMS; 

11 (C) field EMS practitioners, including phy12 sicians, emergency medical technicians, para13 medics, nurses, and other relevant clinicians 

14 providing emergency medical care in the field; 

15 (D) field EMS educational and clinical re16 search; 

17 (E) bridge programs among field EMS, 

18 nursing, and other allied health professions; 

19 (F) field EMS management; 

20 (G) national evidence-based guidelines; and 

21 (H) translation of the lessons learned in 

22 military medicine to field EMS; 

23 (3) evaluate education and training courses and 

24 methodologies to identify optimal educational modal25 ities for field EMS practitioners; 


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1 (4) improve the field EMS education infrastruc2 ture by increasing the number of field EMS instruc3 tors and the quality of their preparation by improv4 ing, enhancing, and modernizing the dissemination 

5 of EMS education, including distance learning, and 

6 by establishing quality improvement for EMS edu7 cation programs; 

8 (5) enhance the opportunity for medical direc9 tion training and for promoting appropriate medical 

10 oversight of field emergency medical care; 

11 (6) improve systems to design, implement, and 

12 evaluate education for prospective and current field 

13 EMS providers; or 

14 (7) carrying out such other activities as the 

15 Secretary may identify. 

16 (d) PRIORITY.—The Secretary of Health and Human 

17 Services, in consultation with NHTSA and relevant stake18 holders, and taking into consideration the recommenda19 tions of FICEMS and NEMSAC, shall establish a system 

20 of prioritization in awarding grants under this section to 

21 eligible entities. 

22 (e) DURATION OF GRANTS.—Grants under this sec23 tion shall be for a period of 1 to 3 years. 

24 (f) APPLICATION.—The Secretary of Health and 

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1 ty under this section unless the entity submits an applica2 tion to the Secretary in such form, in such manner, and 

3 containing such agreements, assurances, and information 

4 as the Secretary may require. The Secretary shall ensure 

5 that the requirements for submitting an application under 

6 this section are not unduly burdensome. 

7 SEC. 9. EVALUATING INNOVATIVE MODELS FOR ACCESS 

8 AND DELIVERY OF FIELD EMS FOR PATIENTS. 

9 (a) EVALUATION.— 

10 (1) IN GENERAL.—Not later than 1 year after 

11 the date of the enactment of this Act, the Secretary 

12 of Health and Human Services, in consultation with 

13 the Administrator of NHTSA, and taking into con14 sideration the recommendations of NEMSAC and 

15 FICEMS, shall complete an evaluation of— 

16 (A) alternative delivery models for medical 

17 care through field EMS; and 

18 (B) the integration of field EMS patients 

19 with other medical providers and facilities as 

20 medically appropriate. 

21 (2) SPECIFIC ISSUES.—The evaluation under 

22 paragraph (1) shall consider each of the following: 

23 (A) Alternative dispositions of low-acuity 

24 patients (as defined by the Secretary of Health 

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1 tients by ambulance to destinations other than 

2 a hospital such as the office of the patient’s 

3 physician, an urgent care center, or the facili4 ties of another health care provider as medically 

5 necessary and appropriate. 

6 (B) Medical liability issues associated with 

7 transport to destinations other than a hospital 

8 emergency department. 

9 (C) Necessary protections to ensure that 

10 patients receive the appropriate care in the ap11 propriate setting without delay. 

12 (D) Whether there are any barriers to pro13 viding alternate dispositions to low-acuity pa14 tients who are not in need of care in hospital 

15 emergency departments. 

16 (E) Other issues determined by the Sec17 retary of Health and Human Services, includ18 ing, when possible, issues recommended by 

19 FICEMS or NEMSAC for evaluation under 

20 this subsection. 

21 (b) DEMONSTRATION PROJECTS.— 

22 (1) IN GENERAL.—Beginning not later than 1 

23 year after the date of the enactment of this Act, the 

24 Secretary of Health and Human Services shall con25 duct or support up to 5 demonstration projects to— 


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1 (A) evaluate the implementation of alter2 native dispositions of low-acuity field EMS pa3 tients (such as transporting patients by ambu4 lance to alternate destinations when medically 

5 appropriate and in the patients’ best interests); 

6 and 

7 (B) determine whether such dispositions— 

8 (i) improve the safety, effectiveness, 

9 timeliness, and efficiency of EMS; and 

10 (ii) reduce overall utilization and ex11 penditures under the Medicare program 

12 under title XVIII of the Social Security 

13 Act. 

14 (2) EVIDENCE-BASED PROTOCOLS.—The Sec15 retary of Health and Human Services shall ensure 

16 that at least one demonstration project under para17 graph (1) evaluates evidence-based protocols that 

18 give guidance on selection of the destination to 

19 which patients are transported. 

20 (3) DURATION.—The period of a demonstration 

21 project under paragraph (1) shall not exceed 36 

22 months. 

23 (4) RESEARCH.—If the Secretary of Health and 

24 Human Services determines that further research is 

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1 onstration projects under this subsection in order to 

2 evaluation the implementation of alternative disposi3 tions of low-acuity field EMS patients, the Secretary 

4 shall conduct or support such research. 

5 (5) AUTHORIZATION OF APPROPRIATIONS.—Of 

6 the amount made available to carry out section 

7 1115A of the Social Security Act (42 U.S.C. 1315a) 

8 for a fiscal year, there are authorized to be appro9 priated such sums as may be necessary to carry out 

10 this subsection. 

11 (c) REPORT TO CONGRESS.—Not later than 1 year 

12 after the completion of all demonstration projects under 

13 subsection (b), the Secretary of Health and Human Serv14 ices shall submit to the Congress a report on the results 

15 of activities under this section, including recommendations 

16 on the efficacy of alternative dispositions of low-acuity 

17 field EMS patients. 

18 SEC. 10. ENHANCING RESEARCH IN FIELD EMS. 

19 (a) MODELS TO BE TESTED BY CENTER FOR MEDI20 CARE AND MEDICAID INNOVATION.—Section 

21 1115A(b)(2)(B) of title XI of the Social Security Act (42 

22 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end 

23 the following: 

24 ‘‘(xxi) Enhancing health outcomes for 

25 patients receiving field emergency medical 


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1 services and improving timely and efficient 

2 delivery of high-quality field emergency 

3 medical services, such as through regional4 ization of emergency care or medical trans5 port to alternate destinations.’’. 

6 (b) EMERGENCY MEDICAL RESEARCH.—Section 

7 498D of the Public Health Service Act (42 U.S.C. 289g– 

8 4) is amended— 

9 (1) by redesignating subsections (c) and (d) as 

10 subsections (d) and (e), respectively; and 

11 (2) by inserting after subsection (b) the fol12 lowing: 

13 ‘‘(c) FIELD EMS EMERGENCY MEDICAL RE14 SEARCH.—The Secretary shall conduct research and eval15 uation relating to field EMS through the Agency for 

16 Healthcare Research and Quality and the Center for Medi17 care and Medicaid Innovation.’’. 

18 (c) FIELD EMS PRACTICE CENTER.—Subpart II of 

19 part D of title IX of the Public Health Service Act (42 

20 U.S.C. 299b–33 et seq.) is amended by adding at the end 

21 the following: 

22 ‘‘SEC. 938. FIELD EMS PRACTICE CENTER. 

23 ‘‘(a) ESTABLISHMENT.—For the purpose described 

24 in subsection (b), the Director shall establish within the 

25 Agency a Field EMS Evidence-Based Practice Center. 


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1 ‘‘(b) PURPOSE.—The purpose of the Center is to con2 duct or support research to promote the highest quality 

3 of emergency medical care in field EMS and the most ef4 fective delivery system for the provision of such care. Re5 search conducted or supported pursuant to the preceding 

6 sentence shall include— 

7 ‘‘(1) comparative effectiveness research; 

8 ‘‘(2) other appropriate clinical or systems re9 search; and 

10 ‘‘(3) research addressing— 

11 ‘‘(A) critical care transport; 

12 ‘‘(B) off-shore operations; 

13 ‘‘(C) tactical emergency medical services; 

14 and 

15 ‘‘(D) the application of lessons learned in 

16 military field medicine in the delivery of emer17 gency medical care in field EMS. 

18 ‘‘(c) DEFINITION.—In this section: 

19 ‘‘(1) The term ‘Center’ means the Field EMS 

20 Evidence-Based Practice Center established under 

21 subsection (a). 

22 ‘‘(2) The term ‘field EMS’ has the meaning 

23 given to such term in section 3 of the Field EMS 

24 Quality, Innovation, and Cost Effectiveness Improve25 ments Act of 2010.’’. 


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1 (d) LIMITATIONS ON CERTAIN USES OF RE2 SEARCH.—Section 1182 of the Social Security Act (42 

3 U.S.C. 1320e–1) is amended by striking ‘‘section 1181’’ 

4 each place it appears and inserting ‘‘section 1181 of this 

5 Act or section 498D(c) or 938 of the Public Health Serv6 ice Act’’. 

7 (e) REGULATORY BARRIERS.—For the purposes of 

8 research conducted pursuant to this section or any other 

9 research funded by the Department of Health and Human 

10 Services related to emergency medical services in the field 

11 in which informed consent is required but may not be at12 tainable, the Secretary of Health and Human Services 

13 shall— 

14 (1) evaluate and consider the patient and re15 search issues involved; and 

16 (2) address regulatory barriers to such research 

17 related to the need for informed consent in a man18 ner that ensures adequate patient safety and notifi19 cation, and submit recommendations to Congress for 

20 any changes to Federal statutes necessary to ad21 dress such barriers. 


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1 SEC. 11. NATIONAL EMERGENCY MEDICAL SERVICES ADVI2 SORY COUNCIL. 

3 (a) ESTABLISHMENT.—The Administrator of 

4 NHTSA shall establish and administer a National Emer5 gency Medical Services Advisory Council. 

6 (b) DUTIES AND AUTHORITIES.— 

7 (1) IN GENERAL.—NEMSAC— 

8 (A) shall provide advice and recommenda9 tions regarding Federal field EMS programs 

10 and activities to NHTSA, FICEMS, and other 

11 Federal agencies that deliver field EMS or sup12 port State or local field EMS; 

13 (B) may, upon request by any Federal 

14 agency, provide that agency with recommenda15 tions on field EMS matters; and 

16 (C) shall provide a national forum for indi17 viduals and entities outside of the Federal Gov18 ernment to deliberate on field EMS issues. 

19 (2) AUTHORITY.—In carrying out paragraph 

20 (1), NEMSAC may gather data and provide advice 

21 and recommendations on— 

22 (A) the national strategy under section 

23 4(b); 

24 (B) any grant program established under 

25 this Act; 


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1 (C) any data collection improvement activ2 ity under this Act; 

3 (D) compliance with any requirement im4 posed under this Act; 

5 (E) any Federal field EMS program or ac6 tivity; 

7 (F) strengthening field EMS systems 

8 through enhanced workforce development, edu9 cation, training, exercises, equipment, medical 

10 oversight, or otherwise; 

11 (G) improved Federal coordination and 

12 support of EMS systems; and 

13 (H) other field EMS issues for which rec14 ommendations are solicited by the Adminis15 trator of NHTSA, FICEMS, or other Federal 

16 agencies. 

17 (c) APPOINTMENT, TERMS, AND MEMBERS.— 

18 (1) IN GENERAL.—NEMSAC shall be composed 

19 of not more than 26 members, each appointed by the 

20 Administrator of NHTSA. 

21 (2) TERMS.— 

22 (A) IN GENERAL.—Except as provided in 

23 subparagraph (B), the Administrator of 

24 NHTSA shall appoint the members of 

25 NEMSAC to serve for a term of 3 years. 


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1 (B) INITIAL MEMBERS.—Of the initial 

2 members of NEMSAC— 

3 (i) not more than 8 shall be appointed 

4 for a term of 1 year; 

5 (ii) not more than 8 shall be ap6 pointed for a term of 2 years; and 

7 (iii) not more than 10 shall be ap8 pointed for a term of 3 years. 

9 (3) ELIGIBILITY.—No official or employee of 

10 the Federal Government may serve as a member of 

11 NEMSAC. 

12 (4) SELECTION.—In appointing the members of 

13 NEMSAC, the Administrator of NHTSA shall— 

14 (A) select members based on their indi15 vidual expertise, not as representatives of spe16 cific organizations; 

17 (B) ensure that the membership of 

18 NEMSAC— 

19 (i) includes balanced representation 

20 across the field EMS community; and 

21 (ii) has sufficient EMS expertise and 

22 geographic and demographic diversity to 

23 accurately reflect the EMS community as a 

24 whole; 


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1 (C) to the extent practical, ensure that the 

2 membership of NEMSAC includes representa3 tion of— 

4 (i) volunteer EMS; 

5 (ii) fire-based EMS; 

6 (iii) nongovernmental EMS; 

7 (iv) hospital-based EMS; 

8 (v) tribal EMS; 

9 (vi) air medical EMS; 

10 (vii) local EMS service director/admin11 istrators; 

12 (viii) EMS medical directors; 

13 (ix) emergency physicians; 

14 (x) trauma surgeons; 

15 (xi) pediatric emergency physicians; 

16 (xii) State EMS directors; 

17 (xiii) State highway safety directors; 

18 (xiv) EMS educators; 

19 (xv) public safety call-takers and dis20 patchers; 

21 (xvi) EMS data managers; 

22 (xvii) EMS researchers; 

23 (xviii) emergency nurses; 

24 (xix) hospital administration; 

25 (xx) public health; 


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1 (xxi) emergency management; 

2 (xxii) State homeland security direc3 tors; 

4 (xxiii) State or local legislative bodies; 

5 and 

6 (xxiv) consumers not directly affiliated 

7 with an emergency medical system or 

8 health care organization; and 

9 (D) appoint at least 2 members without re10 gard to the categories listed in subparagraph 

11 (C). 

12 (5) VACANCIES.—A vacancy in the membership 

13 of NEMSAC shall— 

14 (A) not affect the powers of NEMSAC; 

15 and 

16 (B) be filled in the manner in which the 

17 original appointment was made. 

18 (6) NO PAY; TRAVEL EXPENSES.—Each mem19 ber of NEMSAC shall serve without pay, but shall 

20 be reimbursed for travel and per diem in lieu of sub21 sistence expenses during the performance of duties 

22 of NEMSAC while away from home or his or her 

23 regular place of business, in accordance with appli24 cable provisions under subchapter I of chapter 57 of 

25 title 5, United States Code. 


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1 (7) CHAIRPERSON.—The Administrator of 

2 NHTSA shall select the Chairperson of NEMSAC 

3 from its members. 

4 (d) MEETINGS.—Beginning with the first calendar 

5 year following the enactment of this Act, NEMSAC shall 

6 meet at least twice per calendar year. 

7 (e) PERSONNEL; REIMBURSEMENT FOR SERVICES.— 

8 (1) DETAIL OF NHTSA PERSONNEL.—The Ad9 ministrator of NHTSA shall detail to NEMSAC, 

10 without reimbursement, such personnel of NHTSA 

11 as the Administrator determines necessary to carry 

12 out this section. 

13 (2) REIMBURSEMENT FOR CERTAIN SERV14 ICES.—If NEMSAC performs services at the request 

15 of a Federal agency, such agency shall reimburse 

16 NHTSA for the actual cost of such services. The 

17 Administrator of NHTSA shall establish the method 

18 for calculating and providing reimbursement under 

19 the preceding sentence. 

20 (f) FEDERAL ADVISORY COMMITTEE ACT.—Except 

21 as inconsistent with this section, NEMSAC shall operate 

22 in accordance with the Federal Advisory Committee Act 

23 (5 U.S.C. App.). 


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1 (g) DURATION.—Notwithstanding section 14 of the 

2 Federal Advisory Committee Act (5 U.S.C. App.), 

3 NEMSAC shall be of permanent duration. 

4 (h) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, 

5 AND ADMINISTRATIVE ACTIONS.—All functions, per6 sonnel, assets, and liabilities of, and administrative actions 

7 applicable to, the National Emergency Medical Services 

8 Advisory Council of the Department of Transportation, as 

9 in existence on the day before the date of the enactment 

10 of this Act, shall be transferred to the National Emer11 gency Medical Services Advisory Council established under 

12 this section. 

13 (i) ANNUAL REPORTS.—Each year, NEMSAC shall 

14 submit to NHTSA and FICEMS a report describing 

15 NEMSAC’s activities, positions, and recommendations. 

16 The Administrator of NHTSA shall promptly provide each 

17 such report to the appropriate congressional committees 

18 of jurisdiction. 

19 SEC. 12. EMERGENCY CARE COORDINATION. 

20 (a) IN GENERAL.—Subtitle B of title XXVIII of the 

21 Public Health Service Act (42 U.S.C. 300hh–10 et seq.) 

22 is amended by adding at the end the following: 

23 ‘‘SEC. 2816. EMERGENCY CARE COORDINATION. 

24 ‘‘(a) EMERGENCY CARE COORDINATION CENTER.— 


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1 ‘‘(1) ESTABLISHMENT.—The Secretary shall es2 tablish, within the Office of the Assistant Secretary 

3 for Preparedness and Response, an Emergency Care 

4 Coordination Center (in this section referred to as 

5 the ‘Center’), to be headed by a Director. 

6 ‘‘(2) DUTIES.—The Secretary, acting through 

7 the Director of the Center, in coordination with the 

8 Federal Interagency Committee on Emergency Med9 ical Services, shall— 

10 ‘‘(A) promote and fund research in emer11 gency medicine and trauma health care; 

12 ‘‘(B) promote regional partnerships and 

13 more effective emergency medical systems in 

14 order to enhance appropriate triage, distribu15 tion, and care of routine community patients; 

16 and 

17 ‘‘(C) promote local, regional, and State 

18 emergency medical systems’ preparedness for 

19 and response to public health events. 

20 ‘‘(b) COUNCIL OF EMERGENCY CARE.— 

21 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

22 through the Director of the Center, shall establish a 

23 Council of Emergency Care to provide advice and 

24 recommendations to the Director on carrying out 

25 this section. 


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1 ‘‘(2) COMPOSITION.—The Council shall be com2 prised of employees of the departments and agencies 

3 of the Federal Government who are experts in emer4 gency care and management. 

5 ‘‘(c) REPORT.— 

6 ‘‘(1) SUBMISSION.—Not later than 12 months 

7 after the date of the enactment of this section, the 

8 Secretary shall submit to the Congress an annual re9 port on the activities carried out under this section. 

10 ‘‘(2) CONSIDERATIONS.—In preparing a report 

11 under paragraph (1), the Secretary shall consider 

12 factors including— 

13 ‘‘(A) emergency department crowding and 

14 boarding; and 

15 ‘‘(B) delays in care following presen16 tation.’’. 

17 (b) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, 

18 AND ADMINISTRATIVE ACTIONS.—All functions, per19 sonnel, assets, and liabilities of, and administrative actions 

20 applicable to, the Emergency Care Coordination Center, 

21 as in existence on the day before the date of the enactment 

22 of this Act, shall be transferred to the Emergency Care 

23 Coordination Center established under section 2816(a) of 

24 the Public Health Service Act, as added by subsection (a). 


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1 SEC. 13. EMERGENCY MEDICAL SERVICES TRUST FUND. 

2 (a) DESIGNATION OF INCOME TAX OVERPAYMENTS

3 AND ADDITIONAL CONTRIBUTIONS FOR EMERGENCY

4 MEDICAL SERVICES.—Subchapter A of chapter 61 of the 

5 Internal Revenue Code of 1986 (relating to returns and 

6 records) is amended by adding at the end the following 

7 new part: 

8 ‘‘PART IX—DESIGNATION OF INCOME TAX OVER9 PAYMENTS AND ADDITIONAL CONTRIBU10 TIONS FOR EMERGENCY MEDICAL SERVICES 

11 ‘‘SEC. 6097. DESIGNATION BY INDIVIDUALS. 

12 ‘‘(a) IN GENERAL.—Every individual (other than a 

13 nonresident alien)— 

14 ‘‘(1) may designate that a specified portion of 

15 any overpayment of tax for a taxable year, and 

16 ‘‘(2) may designate that an amount in addition 

17 to any payment of tax for such taxable year and any 

18 designation under paragraph (1), 

19 shall be used to fund the Emergency Medical Services 

20 Trust Fund. Designations under the preceding sentence 

21 shall be in an amount not less than $1 and the Secretary 

22 shall provide for elections in amounts of $1, $5, $10, or 

23 such other amount as the taxpayer designates. 

24 ‘‘(b) ADJUSTED INCOME TAX LIABILITY.—For pur25 poses of this section, the term ‘adjusted income tax liabil26 ity’ means income tax liability (as defined in section 


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1 6096(b)) reduced by any amount designated under section 

2 6096 (relating to designation of income tax payments to 

3 Presidential Election Campaign Fund). 

4 ‘‘(c) OVERPAYMENTS TREATED AS REFUNDED.—For 

5 purposes of this title, any portion of an overpayment of 

6 tax designated under subsection (a) shall be treated as— 

7 ‘‘(1) being refunded to the taxpayer as of the 

8 last date prescribed for filing the return of tax im9 posed by chapter 1 (determined without regard to 

10 extensions) or, if later, the date the return is filed, 

11 and 

12 ‘‘(2) a contribution made by such taxpayer on 

13 such date to the United States. 

14 ‘‘(d) MANNER AND TIME OF DESIGNATION.—A des15 ignation under subsection (a) may be made with respect 

16 to any taxable year— 

17 ‘‘(1) at the time of filing the return of the tax 

18 imposed by chapter 1 for such taxable year, or 

19 ‘‘(2) at any other time (after the time of filing 

20 the return of the tax imposed by chapter 1 for such 

21 taxable year) specified in regulations prescribed by 

22 the Secretary. 

23 Such designation shall be made in such manner as the 

24 Secretary prescribes by regulations except that, if such 

25 designation is made at the time of filing the return of the 


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1 tax imposed by chapter 1 for such taxable year, such des2 ignation shall be made either on the first page of the re3 turn or on the page bearing the signature of the tax4 payer.’’. 

5 (b) EMERGENCY MEDICAL SERVICES TRUST

6 FUND.—Subchapter A of chapter 98 of the Internal Rev7 enue Code of 1986 is amended by adding at the end the 

8 following new section: 

9 ‘‘SEC. 9512. EMERGENCY MEDICAL SERVICES TRUST FUND. 

10 ‘‘(a) CREATION OF TRUST FUND.—There is estab11 lished in the Treasury of the United States a trust fund 

12 to be known as the ‘Emergency Medical Services Trust 

13 Fund’, consisting of such amounts as may be credited or 

14 paid to such trust fund as provided in section 6097. 

15 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here16 by appropriated to the Emergency Medical Services Trust 

17 Fund amounts equivalent to the amounts of the overpay18 ments of tax to which designations under section 6097 

19 apply. 

20 ‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts 

21 in the Emergency Medical Services Trust Fund shall be 

22 available, as provided in appropriation Acts, only for pur23 poses of making expenditures to carry out section 14(a)(2) 

24 of the Field EMS Quality, Innovation, and Cost Effective25 ness Improvements Act of 2010. If, for any fiscal year, 


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1 amounts remain in the Emergency Medical Services Trust 

2 Fund after making such expenditures, such amounts shall 

3 be available, as provided in appropriation Acts, to carry 

4 out sections 498D, 1203, and 1204 of the Public Health 

5 Service Act; part D of title XII of such Act; and part H 

6 of title XII of such Act.’’. 

7 (c) CLERICAL AMENDMENTS.— 

8 (1) CLERICAL AMENDMENT.—The table of 

9 parts for subchapter A of chapter 61 of the Internal 

10 Revenue Code of 1986 is amended by adding at the 

11 end the following new item: 

‘‘PART. IX. DESIGNATION OF INCOME TAX OVERPAYMENTS AND ADDITIONAL

CONTRIBUTIONS FOR EMERGENCY MEDICAL SERVICES.’’. 

12 (2) The table of sections for subchapter A of 

13 chapter 98 of such Code is amended by adding at 

14 the end the following new item: 

‘‘Sec. 9512. Emergency Medical Services Trust Fund.’’. 

15 (d) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply to taxable years beginning after 

17 December 31, 2010. 

18 SEC. 14. AUTHORIZATION OF APPROPRIATIONS. 

19 (a) IN GENERAL.—Out of monies in the Emergency 

20 Medical Services Trust Fund, there are authorized to be 

21 appropriated— 

22 (1) $11,000,000 shall be for carrying out sec23 tions 4, 7, 9(a), 9(c), and 11 of this Act, and section 


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1 2816 of the Public Health Service Act (as added by 

2 section 12 of this Act) for each of fiscal years 2013 

3 through 2015; 

4 (2) $200,000,000 shall be for carrying out sec5 tion 5 of this Act for each of fiscal years 2012 

6 through 2015; 

7 (3) $50,000,000 shall be for carrying out sec8 tion 6 of this Act for each of fiscal years 2012 

9 through 2015; 

10 (4) $15,000,000 shall be for carrying out sec11 tion 8 of this Act for each of fiscal years 2012 

12 through 2015; and 

13 (5) $45,000,000 shall be for carrying out sec14 tions 498D(c) and 938 of the Public Health Service 

15 Act, as added by subsections (b) and (c) of section 

16 10 of this Act, for each of fiscal years 2012 through 

17 2015. 

18 (b) START-UP FUNDING.— 

19 (1) There are authorized to be appropriated 

20 $11,000,000 for each of fiscal years 2011 and 2012 

21 to carry out the provisions specified in subsection 

22 (a)(1). 

23 (2) There are authorized to be appropriated 

24 $50,000,000 for fiscal year 2012 to carry out the 

25 provisions specified in paragraphs (2), (3), (4), and 


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1 (5) of subsection (a), to be allocated in proportion 

2 to the authorizations of appropriations specified in 

3 such paragraphs. The amount of funds authorized to 

4 be appropriated under subsection (a) for fiscal year 

5 2012 (out of any monies in the Emergency Medical 

6 Services Trust Fund) shall be reduced by the 

7 amount of any funds made available under this 

8 paragraph. 

9 (c) ADMINISTRATIVE EXPENSES.—Of the amount 

10 made available under subsection (a) or (b) to carry out 

11 each of the provisions specified in subsection (a), not more 

12 than 5 percent of each such amount may be used for Fed13 eral administrative expenses. 

Æ 


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