II 

113TH CONGRESS 

2D SESSION S. 2400 

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

other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 22, 2014 

Mr. BENNET (for himself, Mr. CRAPO, and Mr. JOHNSON of South Dakota) 

introduced the following bill; which was read twice and referred to the 

Committee on Health, Education, Labor, and Pensions 

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 Innovation Act’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Recognition of HHS as primary Federal agency for emergency medical 

services and trauma care. 

Sec. 4. Emergency medical services. 

Sec. 5. Enhancing research in field EMS. 


jbell on DSK4SPTVN1PROD with BILLS
2 

•S 2400 IS

Sec. 6. Emergency Medical Services Trust Fund. 

Sec. 7. Authorization of appropriations. 

Sec. 8. Statutory construction. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) All persons throughout the United States 

4 should have access to and receive high-quality emer5 gency medical care as part of a coordinated emer6 gency medical services system. 

7 (2) Properly functioning emergency medical 

8 services (referred to in this section as ‘‘EMS’’) sys9 tems, 24 hours per day, 7 days per week, are essen10 tial to ensure access to emergency medical care and 

11 transport for all patients with emergency medical 

12 conditions. Such coordinated EMS systems are also 

13 necessary for response 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 

18 Federal, State, and local multijurisdictional collabo19 ration and sufficient resources for EMS agencies 

20 and providers. 

21 (4) At the Federal level, EMS responsibilities 

22 and resources of several Federal agencies consistent 

23 with their expertise and authority must emphasize 

24 the critical importance of Federal agency collaboraVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
3 

•S 2400 IS

1 tion and coordination for all emergency medical serv2 ices. 

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

4 and agencies require the coordination and improved 

5 capabilities of multiple and diverse stakeholders. 

6 (6) Emergency medical services encompass the 

7 provision of care provided to patients with emer8 gency medical conditions throughout the continuum, 

9 including emergency medical care and trauma care 

10 provided in the field, hospital, and rehabilitation set11 tings. 

12 (7) Field EMS comprises essential emergency 

13 medical services, including medical care or medical 

14 transport provided to patients prior to or outside 

15 medical facilities and other clinical settings. The pri16 mary purpose of field emergency medical services is 

17 to ensure that emergency medical patients receive 

18 the right care at the right place in the right amount 

19 of time. 

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

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

22 essential public service provided by governmental 

23 and nongovernmental agencies and practitioners 24 

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

25 incidents. To ensure disaster and all-hazards preVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
4 

•S 2400 IS

1 paredness for EMS operations as part of the Na2 tion’s comprehensive disaster preparedness, Federal 

3 funding for preparedness activities, including cata4 strophic training and drills, must be provided to gov5 ernmental and nongovernmental EMS agencies to 

6 ensure a greater capability within each of these 

7 areas. 

8 (9) Numerous recommendations from several 

9 significant national reports and documents have 

10 demonstrated the need in multiple areas for substan11 tial improvement of emergency medical services pro12 vided in the field, including recommendations in the 

13 ‘‘EMS Agenda for the Future’’ of the National 

14 Highway Traffic Safety Administration and the 

15 Health Resources and Services Administration, the 

16 Institute of Medicine report ‘‘The Future of Emer17 gency Care in the United States Health System’’, 

18 and the ‘‘EMS Education Agenda for the Future: A 

19 Systems Approach’’, and recommendations of the 

20 National EMS Workforce Injury and Illness Surveil21 lance Program, the National EMS Advisory Council 

22 of the Department of Transportation, and the Fed23 eral Interagency Committee on Emergency Medical 

24 Services. 


jbell on DSK4SPTVN1PROD with BILLS
5 

•S 2400 IS

1 (10) To substantially improve field EMS, ad2 vancements must be made in several essential areas 

3 including readiness, innovation, preparedness, edu4 cation and workforce development, safety, financing, 

5 quality, standards, and research. 

6 (11) The recognition of a primary pro7 grammatic Federal agency for emergency medical 

8 services within the Department of Health and 

9 Human Services was recommended by the Institute 

10 of Medicine and is necessary to provide a more 

11 streamlined, cost-efficient, and comprehensive ap12 proach for field EMS and a focal point for practi13 tioners and agencies to interface with the Federal 

14 Government. 

15 (12) The essential role of field EMS in disaster 

16 preparedness and response must be incorporated 

17 into the national preparedness and response strategy 

18 and implementation as provided and overseen by the 

19 Department of Homeland Security and the Depart20 ment of Health and Human Services pursuant to 

21 their respective jurisdictions. 

22 (13) The essential role of the National Highway 

23 Traffic Safety Administration in the continued de24 velopment of the National EMS Information System 

25 and in overseeing transportation issues related to 


jbell on DSK4SPTVN1PROD with BILLS
6 

•S 2400 IS

1 field EMS such as EMS and ambulance vehicle safe2 ty standards should be maintained. 

3 (14) The Federal Interagency Committee on 

4 Emergency Medical Services must continue in its es5 sential role in coordinating the Federal activities re6 lated to the full spectrum of EMS. 

7 SEC. 3. RECOGNITION OF HHS AS PRIMARY FEDERAL 

8 AGENCY FOR EMERGENCY MEDICAL SERV9 ICES AND TRAUMA CARE. 

10 Title XXVIII of the Public Health Service Act (42 

11 U.S.C. 300hh et seq.) is amended by adding at the end 

12 the following: 

13 ‘‘Subtitle D—Office of EMS and 

14 Trauma 

15 ‘‘SEC. 2831. RECOGNITION OF HHS AS PRIMARY FEDERAL 

16 AGENCY FOR EMERGENCY MEDICAL SERV17 ICES AND TRAUMA CARE; ESTABLISHMENT 

18 OF OFFICE OF EMS AND TRAUMA. 

19 ‘‘(a) PRIMARY FEDERAL AGENCY.—The Department 

20 of Health and Human Services shall serve as the primary 

21 Federal agency with responsibility for programs and ac22 tivities relating to emergency medical services and trauma 

23 care. 

24 ‘‘(b) OFFICE OF EMS AND TRAUMA.— 


jbell on DSK4SPTVN1PROD with BILLS
7 

•S 2400 IS

1 ‘‘(1) ESTABLISHMENT.—There is established 

2 within the Department of Health and Human Serv3 ices an Office of Emergency Medical Services and 

4 Trauma, also to be known as the ‘Office of EMS 

5 and Trauma’. The Office of EMS and Trauma shall 

6 be headed by a director appointed by the Secretary 

7 (referred to in this section as the ‘Director’). 

8 ‘‘(2) ROLE OF OFFICE WITHIN HHS.— 

9 ‘‘(A) IN GENERAL.—The Office of EMS 

10 and Trauma shall have— 

11 ‘‘(i) the responsibilities delegated to 

12 the Office of EMS and Trauma pursuant 

13 to paragraph (3); and 

14 ‘‘(ii) such responsibilities and authori15 ties as may be delegated or transferred to 

16 the Office of EMS and Trauma pursuant 

17 to subparagraph (B). 

18 ‘‘(B) ADDITIONAL RESPONSIBILITIES AND

19 AUTHORITIES.—In addition to the responsibil20 ities and authorities specified in subparagraph 

21 (A), the Secretary may delegate or transfer to 

22 the Office of EMS and Trauma any other re23 sponsibility or authority of the Department of 

24 Health and Human Services relating to emer25 gency medical services and trauma care (except 


jbell on DSK4SPTVN1PROD with BILLS
8 

•S 2400 IS

1 that the Secretary may not delegate or transfer 

2 such responsibilities or authorities that are oth3 erwise granted to a specific agency within the 

4 Department in statute), including such services 

5 and care relating to— 

6 ‘‘(i) the full continuum of emergency 

7 medical services, including field EMS and 

8 trauma and hospital emergency medical 

9 care; and 

10 ‘‘(ii) improving the quality, innova11 tion, or cost effectiveness of emergency 

12 medical services. 

13 ‘‘(C) LOCATION OF OFFICE IN HHS.—The 

14 Secretary shall locate the Office of EMS and 

15 Trauma within the organizational structure of 

16 the Department of Health and Human Services 

17 in a manner that achieves each of the following: 

18 ‘‘(i) Recognition of the importance 

19 and unique life-saving services associated 

20 with field EMS, trauma care, and hospital 

21 emergency care as a significant Federal 

22 priority. 

23 ‘‘(ii) Integration of the essential serv24 ices described in clause (i) with the larger 

25 health care system and within the disaster 


jbell on DSK4SPTVN1PROD with BILLS
9 

•S 2400 IS

1 preparedness system, including through re2 gionalization of such services and by en3 hancing daily readiness capabilities to en4 sure adequate disaster readiness capabili5 ties, consistent with the National Health 

6 Security Strategy. 

7 ‘‘(iii) Consolidation, co-location, and 

8 cost efficiencies in administering programs 

9 and activities related to field EMS, trauma 

10 care, and hospital emergency medical care. 

11 ‘‘(iv) Establishment of a Federal focal 

12 point for leadership and improved coordi13 nation, support, and oversight of field 

14 EMS, trauma care, and hospital emergency 

15 medical care. 

16 ‘‘(v) Sufficient level and stature such 

17 that— 

18 ‘‘(I) such Office is able to fulfill 

19 its role, responsibilities, and authori20 ties; and 

21 ‘‘(II) the Director of such Office 

22 reports directly to the Secretary or an 

23 official within the Department who re24 ports directly to the Secretary. 


jbell on DSK4SPTVN1PROD with BILLS
10 

•S 2400 IS

1 ‘‘(vi) Establishment of a visible and 

2 identifiable point of contact with which the 

3 public; EMS agencies and practitioners; 

4 State and local government agencies; EMS 

5 educational institutions; EMS, trauma, 

6 and hospital emergency care professional 

7 associations; and all other parties may 

8 interact. 

9 ‘‘(3) RESPONSIBILITIES.—The Secretary shall, 

10 at a minimum, delegate responsibility to the Office 

11 of EMS and Trauma to carry out section 330J and 

12 parts A, B, C, D, H, and I (except subsection (c)(1) 

13 of section 1294) of title XII. 

14 ‘‘(c) NATIONAL EMS STRATEGY.—The Secretary, 

15 acting through the Director, and in consultation with the 

16 Assistant Secretary for Preparedness and Response and 

17 the Administrator of the Health Resources and Services 

18 Administration, shall develop and implement a cohesive 

19 national EMS strategy to strengthen the development of 

20 the full continuum of EMS at the Federal, State, and local 

21 levels. In establishing such a strategy, the Secretary 

22 shall— 

23 ‘‘(1) solicit and consider the recommendations 

24 of the National Emergency Medical Services Advi25 sory Council as well as relevant stakeholders; 


jbell on DSK4SPTVN1PROD with BILLS
11 

•S 2400 IS

1 ‘‘(2) consult and collaborate with the Federal 

2 Interagency Committee on Emergency Medical Serv3 ices to ensure consistency of such national EMS 

4 strategy within the larger Federal strategy regarding 

5 all of emergency medical services and national pre6 paredness and response; 

7 ‘‘(3) address issues related to EMS patient and 

8 practitioner safety, standardization of EMS practi9 tioner licensing and credentialing, field EMS quality 

10 and medical oversight, regionalization of field EMS 

11 and trauma and emergency care services, availability 

12 of field EMS and trauma care and emergency med13 ical services throughout the Nation, and integration 

14 of field EMS practitioners into the broader health 

15 care system, including— 

16 ‘‘(A) promotion of the adoption by States 

17 of the education standards identified in the 

18 ‘Emergency Medical Services Education Agenda 

19 for the Future: A Systems Approach’ and any 

20 revisions thereto, including the standardization 

21 of licensing and credentialing of field EMS 

22 practitioners and standards of care, based on 

23 best practices and evidence-based medicine, in24 cluding by— 


jbell on DSK4SPTVN1PROD with BILLS
12 

•S 2400 IS

1 ‘‘(i) the identification of differences in 

2 the levels of care, scope of practice, and li3 censure and credentialing requirements 

4 among the States; and 

5 ‘‘(ii) the adoption by the States of na6 tional standards for such levels of care, 

7 scope of practice and licensure and 

8 credentialing requirements; 

9 ‘‘(B) promotion of a culture of safety, in10 cluding— 

11 ‘‘(i) the adoption of an anonymous 

12 error reporting system designed to identify 

13 systemic problems in field EMS patient 

14 and practitioner safety and ensure a single 

15 means of collecting and reporting relevant 

16 error data by field EMS agencies and 

17 States; 

18 ‘‘(ii) the establishment of field EMS 

19 patient and practitioner safety goals and 

20 the specific means to improve field EMS 

21 practitioner and patient safety to achieve 

22 such goals; and 

23 ‘‘(iii) the adoption of more uniform 

24 national ambulance vehicle safety and 

25 manufacturing standards as developed by 


jbell on DSK4SPTVN1PROD with BILLS
13 

•S 2400 IS

1 the National Fire Protection Administra2 tion or coordinated by the National High3 way Traffic Safety Administration; 

4 ‘‘(C) the integration and utilization of field 

5 EMS practitioners as part of the larger health 

6 care system, including— 

7 ‘‘(i) the potential utilization of field 

8 EMS practitioners for the provision of care 

9 to patients with nonemergent medical con10 ditions, such as through mobile integrated 

11 health care services or community 

12 paramedicine; and 

13 ‘‘(ii) strategies to implement the rec14 ommendations provided by the National 

15 Health Care Workforce Commission, pur16 suant to section 5101(d)(2) of the Patient 

17 Protection and Affordable Care Act (42 

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

19 ‘‘(D) such other issues as the Secretary 

20 considers appropriate; 

21 ‘‘(4) incorporate into such strategy the pre22 paredness and response objectives identified by the 

23 Secretary of Homeland Security and the Assistant 

24 Secretary for Preparedness and Response in order— 


jbell on DSK4SPTVN1PROD with BILLS
14 

•S 2400 IS

1 ‘‘(A) to ensure the capability and capacity 

2 of the full spectrum of EMS to respond to ter3 rorist attacks, disasters, catastrophic events, 

4 and mass casualty events; and 

5 ‘‘(B) to coordinate with the Secretary of 

6 Homeland Security accordingly; 

7 ‘‘(5) complete the development of such strategy 

8 not later than 18 months after the date of enact9 ment of this Act; 

10 ‘‘(6) communicate such strategy to the relevant 

11 congressional committees of jurisdiction; 

12 ‘‘(7) implement such strategy, to the extent 

13 practicable, not later than 3 years after the date of 

14 enactment of the Field EMS Innovation Act; and 

15 ‘‘(8) update such strategy not less than every 3 

16 years. 

17 ‘‘(d) DEFINITIONS.—In this section, the terms ‘field 

18 EMS’, ‘emergency medical services’, and ‘medical over19 sight’ have the meaning given such terms in section 

20 1291.’’. 

21 SEC. 4. EMERGENCY MEDICAL SERVICES. 

22 Title XII of the Public Health Service Act (42 U.S.C. 

23 300d et seq.) is amended by adding at the end the fol24 lowing: 


jbell on DSK4SPTVN1PROD with BILLS
15 

•S 2400 IS

1 ‘‘PART I—EMERGENCY MEDICAL SERVICES 

2 ‘‘SEC. 1291. DEFINITIONS. 

3 ‘‘In this part: 

4 ‘‘(1) The term ‘ambulance diversion’ means the 

5 practice of hospitals of denying access to an incom6 ing ambulance and requesting that the ambulance 

7 proceed to another facility due to a stated lack of ca8 pacity at the initial facility, resulting in delayed ac9 cess to definitive care. 

10 ‘‘(2) The term ‘Director’ means the Director of 

11 the Office of EMS and Trauma established under 

12 section 2831. 

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

14 services. 

15 ‘‘(4) The term ‘FICEMS’ means the Federal 

16 Interagency Committee on Emergency Medical Serv17 ices. 

18 ‘‘(5) The term ‘field EMS’ means emergency 

19 medical services provided to patients (including 

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

21 outside a medical facility or other clinical setting. 

22 ‘‘(6) The term ‘field EMS agency’ means an or23 ganization providing field EMS, including— 

24 ‘‘(A) governmental (including fire-based 

25 agencies), nongovernmental (including hospitalVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
16 

•S 2400 IS

1 based or private agencies), and volunteer orga2 nizations; and 

3 ‘‘(B) organizations that provide field EMS 

4 by ground, air, or otherwise. 

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

6 ‘EMS’ means emergency medical care, trauma care, 

7 and related services provided to patients at any 

8 point in the continuum of health care services, in9 cluding emergency medical dispatch and emergency 

10 medical care, trauma care, and related services pro11 vided in the field, during transport, or in a medical 

12 facility or other clinical setting. 

13 ‘‘(8) The term ‘field EMS patient care reports’ 

14 means the information that a field EMS agency 

15 typically creates regarding a patient’s medical condi16 tion and treatment in the course of providing emer17 gency medical services to that patient. 

18 ‘‘(9) The term ‘medical oversight’ means the 

19 supervision by a physician of the medical aspects of 

20 an EMS system or agency and its providers, includ21 ing prospective, concurrent, and respective compo22 nents of field EMS and the education of EMS pro23 viders. 

24 ‘‘(10) The term ‘NEMSAC’ means the National 

25 Emergency Medical Services Advisory Council. 


jbell on DSK4SPTVN1PROD with BILLS
17 

•S 2400 IS

1 ‘‘(11) The term ‘NEMSIS’ means the National 

2 EMS Information System. 

3 ‘‘(12) The term ‘NHTSA’ means the National 

4 Highway Traffic Safety Administration. 

5 ‘‘(13) The term ‘patient parking’ means the 

6 practice by hospitals of refusing to accept transfer 

7 of a patient’s care from an ambulance crew until a 

8 regular emergency department bed is available, re9 quiring the crew to continue to provide patient care 

10 on the ambulance stretcher rather than in a patient 

11 bed in the hospital, until hospital staff will accept 

12 the transfer of care, resulting in delayed access to 

13 definitive care. 

14 ‘‘(14) The term ‘State EMS Office’ means an 

15 office designated by the State with primary responsi16 bility for oversight of the State’s EMS system, such 

17 as responsibility for oversight of EMS coordination, 

18 licensing or certifying EMS practitioners, and EMS 

19 system improvement. 

20 ‘‘(15) The term ‘STEMI’ means ST–Segment 

21 Elevation Myocardial Infarction. 

22 ‘‘SEC. 1292. FIELD EMS EXCELLENCE, QUALITY, UNIVERSAL 

23 ACCESS, INNOVATION, AND PREPAREDNESS. 

24 ‘‘(a) IN GENERAL.—The Director shall establish the 

25 an EMS Excellence, Quality, Universal Access, InnovaVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
18 

•S 2400 IS

1 tion, and Preparedness grant program, to be referred to 

2 as the ‘EQUIP grant program’— 

3 ‘‘(1) to promote excellence in all aspects of the 

4 provision of field EMS by field EMS agencies; 

5 ‘‘(2) to enhance the quality of emergency med6 ical care provided to patients by field EMS practi7 tioners through evidence-based, medically directed 

8 field emergency care; 

9 ‘‘(3) to promote universal access to and avail10 ability of high-quality field EMS in all geographic lo11 cations of the Nation; 

12 ‘‘(4) to spur innovation in the delivery of field 

13 EMS; and 

14 ‘‘(5) to improve EMS agency readiness and pre15 paredness for day-to-day emergency medical re16 sponse. 

17 ‘‘(b) APPLICATION.— 

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

19 grant under this section, an eligible entity shall sub20 mit an application to the Director in such form and 

21 manner, and containing such agreements, assur22 ances, and information as the Director determines to 

23 be necessary to carry out this section. 

24 ‘‘(2) SIMPLE FORM.—The Director shall ensure 

25 that grant application requirements are not unduly 


jbell on DSK4SPTVN1PROD with BILLS
19 

•S 2400 IS

1 burdensome to smaller and volunteer field EMS 

2 agencies or other agencies with limited resources. 

3 ‘‘(3) CONSISTENCY WITH PREPARATION

4 GOALS.—The Director shall ensure that grant appli5 cations are consistent with national and relevant 

6 State preparedness plans and goals. 

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

8 entities— 

9 ‘‘(1) to sustain field EMS practitioners to en10 sure 24 hours a day, 7 days a week readiness and 

11 preparedness at the local level; 

12 ‘‘(2) to develop and implement initiatives re13 lated to delivery of medical services, including— 

14 ‘‘(A) innovative clinical practices to im15 prove the cost effectiveness and quality of care 

16 delivered to emergency patients in the field that 

17 results in improved patient outcomes and cost 

18 savings to the health system, including for high 

19 prevalence emergency medical conditions such 

20 as sudden cardiac arrest, STEMI, stroke, and 

21 trauma; and 

22 ‘‘(B) delivery systems to improve patient 

23 outcomes, which may include implementing evi24 dence-based protocols, interventions, systems, 


jbell on DSK4SPTVN1PROD with BILLS
20 

•S 2400 IS

1 and technologies to reduce clinically meaningful 

2 response times; 

3 ‘‘(3) to purchase and implement— 

4 ‘‘(A) medical equipment and training for 

5 using such equipment; 

6 ‘‘(B) communication systems to ensure 

7 seamless and interoperable communications 

8 with other first responders; and 

9 ‘‘(C) information systems to comply with 

10 NEMSIS data collection and integrate field 

11 emergency care with electronic medical records; 

12 ‘‘(4) to participate in federally sponsored field 

13 EMS research; 

14 ‘‘(5) to establish or enhance comprehensive 

15 medical oversight and quality assurance programs 

16 that include the active participation by medical di17 rectors in field EMS medical direction and edu18 cational programs; and 

19 ‘‘(6) for such other uses as the Director deter20 mines appropriate. 

21 ‘‘(d) ADMINISTRATION OF GRANTS.—In establishing 

22 and administering the EQUIP grant program, the Direc23 tor— 

24 ‘‘(1) shall establish a grantmaking process that 

25 includes— 


jbell on DSK4SPTVN1PROD with BILLS
21 

•S 2400 IS

1 ‘‘(A) prioritization for the awarding of 

2 grants to eligible entities and consideration of 

3 the factors in reviewing grant applications by 

4 eligible entities, including— 

5 ‘‘(i) demonstrated financial need for 

6 funding; 

7 ‘‘(ii) utilization of public and private 

8 partnerships; 

9 ‘‘(iii) enhanced access to high-quality 

10 field EMS in under served geographic 

11 areas; 

12 ‘‘(iv) unique needs of volunteer and 

13 rural field EMS agencies; 

14 ‘‘(v) distribution among a variety of 

15 geographic areas, including urban, subur16 ban, and rural; 

17 ‘‘(vi) distribution of funds among 

18 types of EMS agencies, including govern19 mental, nongovernmental and volunteer; 

20 ‘‘(vii) implementation of evidence21 based interventions that improve quality of 

22 care, patient outcomes, efficiency, or cost 

23 effectiveness; and 

24 ‘‘(viii) such other factors as the Direc25 tor determines necessary; 


jbell on DSK4SPTVN1PROD with BILLS
22 

•S 2400 IS

1 ‘‘(B) a peer-reviewed process to rec2 ommend grant allocations in accordance with 

3 the prioritization established by the Director, 

4 except that final award determinations shall be 

5 made by the Director; and 

6 ‘‘(C) the provision of grant awards to eligi7 ble entities on an annual basis, except that the 

8 Director may reserve not more than 25 percent 

9 of the available appropriations for multiyear 

10 grants and no grant award may exceed a 2-year 

11 period; 

12 ‘‘(2) shall consult with and take into consider13 ation the recommendations of the Assistant Sec14 retary for Preparedness and Response, FICEMS, 

15 NEMSAC, and relevant stakeholders; 

16 ‘‘(3) shall ensure that funds used for day-to-day 

17 preparedness activities are consistent and aligned 

18 with Federal preparedness priorities; and 

19 ‘‘(4) may contract with an independent, third20 party, nonprofit organization to administer the grant 

21 program if the Director establishes conflict-of-inter22 est requirements as part of any such contractual re23 lationship. 

24 ‘‘(e) ELIGIBILITY.—Eligible grant recipients are field 

25 EMS agencies that— 


jbell on DSK4SPTVN1PROD with BILLS
23 

•S 2400 IS

1 ‘‘(1) are licensed by or otherwise authorized in 

2 the State in which they operate; and 

3 ‘‘(2) have medical oversight and quality im4 provement programs as defined by the Director. 

5 ‘‘(f) REQUIRED USE OF GUIDELINES.—As a condi6 tion on receipt of a grant under this section, the Director 

7 shall require the grant recipient to adopt and implement 

8 (to the extent applicable) the guidelines promoted, devel9 oped, and disseminated under subparagraphs (B) and (C) 

10 of section 1294(a)(1). 

11 ‘‘(g) ANNUAL REPORT.—The Director shall submit 

12 an annual report on the EQUIP grant program under this 

13 section to Congress. 

14 ‘‘SEC. 1293. FIELD EMS SYSTEM PERFORMANCE, INTEGRA15 TION, AND ACCOUNTABILITY. 

16 ‘‘(a) IN GENERAL.—The Director shall establish a 

17 Field EMS System Performance, Integration, and Ac18 countability grant program, to be referred to as the ‘SPIA 

19 grant program’— 

20 ‘‘(1) to improve field EMS system performance, 

21 integration, and accountability; 

22 ‘‘(2) to ensure preparedness for field EMS at 

23 the State and local levels; 

24 ‘‘(3) to enhance physician medical oversight of 

25 field EMS systems; 


jbell on DSK4SPTVN1PROD with BILLS
24 

•S 2400 IS

1 ‘‘(4) to improve coordination between regional 

2 field EMS systems and integration of such regional 

3 field EMS systems into the larger health care sys4 tem; 

5 ‘‘(5) to enhance data collection and analysis to 

6 improve, on a continuing basis, the field EMS sys7 tem; and 

8 ‘‘(6) to promote standardization of national 

9 EMS certification of emergency medical technicians 

10 and paramedics. 

11 ‘‘(b) USE OF FUNDS.—Entities receiving grants 

12 under this section may use such grant funds— 

13 ‘‘(1) to enhance EMS system readiness and pre14 paredness for day-to-day emergency medical re15 sponse; 

16 ‘‘(2) to improve cross-border collaboration and 

17 planning among States; and 

18 ‘‘(3) to collect data with regard to— 

19 ‘‘(A) NEMSIS; 

20 ‘‘(B) field EMS education; 

21 ‘‘(C) field EMS workforce; 

22 ‘‘(D) cardiac events, including STEMI and 

23 sudden cardiac arrest; 

24 ‘‘(E) stroke; 


jbell on DSK4SPTVN1PROD with BILLS
25 

•S 2400 IS

1 ‘‘(F) disasters, including injuries and ill2 nesses; 

3 ‘‘(G) ambulance diversion and patient 

4 parking; 

5 ‘‘(H) trauma (in a manner that is com6 plementary and not duplicative of other trauma 

7 data collection, such as the National Trauma 

8 Data Bank); 

9 ‘‘(I) data determined necessary by the 

10 State office of EMS for oversight and coordina11 tion of the State field EMS system; and 

12 ‘‘(J) any other such data that the Director 

13 specifies; 

14 ‘‘(4) to implement and evaluate system-wide 

15 quality improvement initiatives, including medical di16 rection at the State, local, and regional levels; 

17 ‘‘(5) to integrate field EMS with other health 

18 care services as part of a coordinated system of care 

19 provided to patients with emergency medical condi20 tions to help ensure the right patient receives the 

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

22 at the right medical facility in the right amount of 

23 time, including by enhancing regional emergency 

24 medical dispatch; 


jbell on DSK4SPTVN1PROD with BILLS
26 

•S 2400 IS

1 ‘‘(6) to incorporate national EMS certification 

2 for all levels of emergency medical technicians and 

3 paramedics; 

4 ‘‘(7) to improve the State’s planning for ensur5 ing a consistent, available EMS workforce; 

6 ‘‘(8) to fund EMS regional and local oversight 

7 and planning organizations or develop regional sys8 tems of emergency medical care within the State to 

9 further enhance coordination and systemic develop10 ment throughout the State; and 

11 ‘‘(9) for such other uses as the Director deter12 mines appropriate. 

13 ‘‘(c) ADMINISTRATION OF GRANTS.—In establishing 

14 and administering the SPIA grant program, the Director 

15 shall— 

16 ‘‘(1) establish State EMS system performance 

17 standards to serve as guidance to States in improv18 ing EMS systems and in applying for grants under 

19 this section, taking into consideration— 

20 ‘‘(A) the recommendations of the Assistant 

21 Secretary for Preparedness and Response, 

22 FICEMS, NEMSAC, and relevant stakeholders; 

23 ‘‘(B) national, evidence-based guidelines; 

24 and 


jbell on DSK4SPTVN1PROD with BILLS
27 

•S 2400 IS

1 ‘‘(C) the needs and resource limitations of 

2 volunteer, smaller agencies, and agencies in 

3 rural areas; 

4 ‘‘(2) provide technical assistance to State EMS 

5 offices in conducting comprehensive EMS planning 

6 with regard to evidence-based workforce and devel7 opment competencies for field EMS management; 

8 ‘‘(3) allocate, within the available funds, SPIA 

9 grants to a maximum of one grant per applicant ac10 cording to a formula based on population and geo11 graphic area, as determined by the Director, for a 

12 period not to exceed 2 years; and 

13 ‘‘(4) require that States allocate a portion of 

14 funds awarded under this section to regional and 

15 local oversight and planning EMS organizations 

16 within the State for the purpose of field EMS sys17 tem development, maintenance, and improvement of 

18 coordination among regional organizations. 

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

20 under this section, an eligible entity shall submit an appli21 cation to the Director in such form and manner, con22 taining such agreements, assurances, and information as 

23 the Director determines to be necessary to carry out this 

24 section. 


jbell on DSK4SPTVN1PROD with BILLS
28 

•S 2400 IS

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

2 under this section are the State EMS office in each of 

3 the several States, Indian tribes, and territories. 

4 ‘‘(f) REQUIRED USE OF GUIDELINES.—As a condi5 tion on receipt of a grant under this section, the Director 

6 shall require the grant recipient to adopt and implement 

7 (to the extent applicable) the guidelines promoted, devel8 oped, and disseminated under subparagraphs (B) and (C) 

9 of section 1294(a)(1). 

10 ‘‘(g) ANNUAL REPORT.—The Director shall submit 

11 an annual report on the SPIA grant program under this 

12 section to Congress. 

13 ‘‘SEC. 1294. FIELD EMS QUALITY. 

14 ‘‘(a) MEDICAL OVERSIGHT.— 

15 ‘‘(1) IN GENERAL.—To improve medical over16 sight of field EMS and ensure continuity and quality 

17 for such medical oversight, the Director shall— 

18 ‘‘(A) promote high-quality and comprehen19 sive medical oversight of— 

20 ‘‘(i) all medical care provided by field 

21 EMS practitioners; and 

22 ‘‘(ii) the education and training of 

23 field EMS practitioners; 

24 ‘‘(B) promote the development, adoption, 

25 and utilization of national guidelines for the 


jbell on DSK4SPTVN1PROD with BILLS
29 

•S 2400 IS

1 roles of physicians who provide medical over2 sight for field EMS and other health care pro3 viders who support physicians in this role; 

4 ‘‘(C) support efforts of relevant physician 

5 stakeholders in developing and disseminating 

6 guidelines for use by EMS medical directors 

7 and field EMS practitioners on a national basis; 

8 and 

9 ‘‘(D) convene a Field EMS Medical Over10 sight Advisory Committee, comprised of rep11 resentatives of relevant physician stakeholders, 

12 to advise the Director on ways and means to 

13 advance and support development and mainte14 nance of quality medical oversight throughout 

15 the Nation’s systems for field EMS. 

16 ‘‘(2) ADDITIONAL CONSIDERATIONS.—In car17 rying out subparagraphs (B) and (C) of paragraph 

18 (1), the Director shall take into consideration— 

19 ‘‘(A) existing guidelines developed by na20 tional professional physician associations, 

21 States, and other relevant governmental or non22 governmental entities; 

23 ‘‘(B) the input of other relevant stake24 holders, including health care providers who 


jbell on DSK4SPTVN1PROD with BILLS
30 

•S 2400 IS

1 support physicians who provide medical over2 sight for field EMS; and 

3 ‘‘(C) the unique needs associated with 

4 medical oversight of provision of field EMS in 

5 rural areas or by volunteers. 

6 ‘‘(3) FLEXIBILITY.—The guidelines promoted, 

7 developed, and disseminated under subparagraphs 

8 (B) and (C) of paragraph (1) shall ensure high-qual9 ity training, credentialing, and direction in connec10 tion with medical oversight of field EMS at the 

11 State, regional, and local levels while providing suffi12 cient flexibility to account for historical and legiti13 mate differences in field EMS among States, re14 gions, and localities. 

15 ‘‘(b) GAO STUDY AND REPORT.— 

16 ‘‘(1) IN GENERAL.—The Comptroller General of 

17 the United States shall complete a study on— 

18 ‘‘(A) medical and administrative liability 

19 issues that may impede— 

20 ‘‘(i) medical direction provided by 

21 physicians directly regarding specific pa22 tients or medical oversight provided by 

23 physicians in establishing medical proto24 cols, procedures, and other activities reVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
31 

•S 2400 IS

1 lated to the provision of emergency medical 

2 care in field EMS; or 

3 ‘‘(ii) the highest quality emergency 

4 medical care in field EMS provided by per5 sonnel other than physicians such as emer6 gency medical technicians and paramedics; 

7 ‘‘(B) reimbursement for any component of 

8 medical oversight; and 

9 ‘‘(C) such other issues as the Comptroller 

10 General determines appropriate relating to im11 proving the quality and medical oversight of 

12 emergency medical care in field EMS. 

13 ‘‘(2) REPORT TO CONGRESS.—Not later than 

14 18 months after the date of the enactment of the 

15 Field EMS Innovation Act, the Comptroller General 

16 shall complete the study under paragraph (1) and 

17 submit a report to Congress on the results of such 

18 study, including any recommendations. 

19 ‘‘(c) DATA COLLECTION AND EXCHANGE.— 

20 ‘‘(1) NATIONAL EMS INFORMATION SYSTEM.— 

21 ‘‘(A) IN GENERAL.—The Administrator of 

22 NHTSA may maintain, improve, and expand 

23 the National EMS Information System, includ24 ing the National EMS Database. 


jbell on DSK4SPTVN1PROD with BILLS
32 

•S 2400 IS

1 ‘‘(B) CONSULTATION.—The Administrator 

2 of NHTSA shall carry out this paragraph in 

3 consultation with the Director. 

4 ‘‘(C) STANDARDIZATION.—In carrying out 

5 subparagraph (A), the Administrator of 

6 NHTSA shall promote the collection and re7 porting of data on field EMS in a standardized 

8 manner. 

9 ‘‘(D) AVAILABILITY OF DATA.—The Ad10 ministrator of NHTSA shall ensure that infor11 mation in the National EMS Database (other 

12 than individually identifiable information) is 

13 available to Federal and State policymakers, 

14 EMS stakeholders, and researchers. 

15 ‘‘(E) TECHNICAL ASSISTANCE.—In car16 rying out subparagraph (A), the Administrator 

17 of NHTSA may provide technical assistance to 

18 State and local agencies, field EMS agencies, 

19 and other entities, as the Administrator deter20 mines appropriate, to assist in the collection, 

21 analysis, and reporting of data. 

22 ‘‘(2) REPORT ON DATA GAPS.— 

23 ‘‘(A) IN GENERAL.—Not later than 1 year 

24 after the date of the enactment of the Field 

25 EMS Innovation Act, the Secretary of Health 


jbell on DSK4SPTVN1PROD with BILLS
33 

•S 2400 IS

1 and Human Services, acting through the Direc2 tor, in consultation with the Administrator of 

3 NHTSA, shall submit to Congress a report 

4 that— 

5 ‘‘(i) identifies gaps in the collection of 

6 data related to the provision of field EMS; 

7 and 

8 ‘‘(ii) includes recommendations for 

9 improving the collection, reporting, and 

10 analysis of such data. 

11 ‘‘(B) RECOMMENDATIONS.—The rec12 ommendations required by subparagraph (A)(ii) 

13 shall— 

14 ‘‘(i) take into consideration the rec15 ommendations of FICEMS and NEMSAC 

16 and relevant stakeholders; 

17 ‘‘(ii) recommend methods for improv18 ing data collection and reporting and anal19 ysis without unduly burdening reporting 

20 entities and without duplicating existing 

21 data sources (such as data collected by the 

22 National Trauma Data Bank); 

23 ‘‘(iii) address the quality and avail24 ability of data, and linkages with existing 

25 patient registries, related to the provision 


jbell on DSK4SPTVN1PROD with BILLS
34 

•S 2400 IS

1 of field EMS and utilization of field EMS 

2 with respect to a variety of illnesses and 

3 injuries (in both the everyday provision of 

4 field EMS and catastrophic or disaster re5 sponse), including— 

6 ‘‘(I) cardiac events such as chest 

7 pain, sudden cardiac arrest, and 

8 STEMI; 

9 ‘‘(II) stroke; 

10 ‘‘(III) trauma; 

11 ‘‘(IV) disaster and catastrophic 

12 incidents, such as incidents related to 

13 terrorism or natural or manmade dis14 asters; and 

15 ‘‘(V) ambulance diversion and 

16 patient parking; and 

17 ‘‘(iv) include an analysis of the variety 

18 of services provided by field EMS agencies. 

19 ‘‘(3) REPORT ON DATA INTEGRATION TO PRO20 MOTE QUALITY OF CARE.—Not later than 18 

21 months after the date of enactment of the Field 

22 EMS Innovation Act, the Secretary, acting through 

23 the head of the Office of the National Coordinator 

24 for Health Information Technology and the Director, 

25 in collaboration with FICEMS and the AdminisVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
35 

•S 2400 IS

1 trator of NHTSA as appropriate, and taking into 

2 consideration input from relevant stakeholders, shall 

3 submit a report (including recommendations) on 

4 issues, impediments, and potential solutions per5 taining to the following objectives: 

6 ‘‘(A) Incorporation of field EMS patient 

7 care reports into patient electronic health 

8 records, taking into consideration— 

9 ‘‘(i) the extent to which field EMS pa10 tient care reports are created in electronic 

11 format and the potential for elements of 

12 such reports to be incorporated into pa13 tient electronic health records; 

14 ‘‘(ii) the data elements of field EMS 

15 patient care reports that would promote 

16 quality and efficiency of care if incor17 porated into patient electronic health 

18 records; 

19 ‘‘(iii) potential modifications to the 

20 Medicare and Medicaid programs under ti21 tles XVIII and XIX, respectively, of the 

22 Social Security Act (42 U.S.C. 1395 et 

23 seq., 1396 et seq.) or other Federal health 

24 programs (including potential modifica25 tions to the HITECH Act (title XIII of diVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
36 

•S 2400 IS

1 vision A and title IV of Division B of Pub2 lic Law 111–5), including modifications to 

3 the entities included as eligible for incen4 tive payments under section 1848(o), 

5 1853(l) (to the extent that such section 

6 1848(o) is applied), or 1903(t) of the So7 cial Security Act (42 U.S.C. 1395w–4(o), 

8 1395w–23(l), 1396b(t)), criteria for cer9 tified EHR technology for purposes of 

10 such sections, and objectives and measures 

11 for determining meaningful use of such 

12 technology for purposes of such sections) 

13 to provide appropriate reimbursement and 

14 financial incentives for EMS agencies— 

15 ‘‘(I) to maintain field EMS pa16 tient care reports in a structured elec17 tronic format; and 

18 ‘‘(II) to otherwise adopt and use 

19 electronic health records; and 

20 ‘‘(iv) potential modifications to the 

21 HITECH Act to provide incentives to eligi22 ble hospitals under section 1886(n), 

23 1853(m) (to the extent that such section 

24 1886(n) is applied), or section 1814(l)(3) 

25 of the Social Security Act to incorporate 


jbell on DSK4SPTVN1PROD with BILLS
37 

•S 2400 IS

1 appropriate data elements of field EMS 

2 patient care reports into patient electronic 

3 health records. 

4 ‘‘(B) Incorporation of patient health infor5 mation created subsequent to the receipt of 

6 field EMS emergency care into NEMSIS, tak7 ing into consideration— 

8 ‘‘(i) the types of medical information 

9 created subsequent to the receipt of field 

10 EMS emergency care (such as outcomes 

11 information or information regarding sub12 sequent care and treatment) that would, if 

13 included in NEMSIS, be potentially useful 

14 in evaluating and improving the quality of 

15 EMS care; 

16 ‘‘(ii) how best to integrate such infor17 mation into NEMSIS; 

18 ‘‘(iii) potential modifications to the 

19 HITECH Act to require eligible hospitals, 

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

21 Social Security Act (42 U.S.C. 

22 1395ww(n)(6)(B)), for purposes of incen23 tive payments under 1886(b)(3)(B)(ix) and 

24 1886(n) of such Act, to develop or report 


jbell on DSK4SPTVN1PROD with BILLS
38 

•S 2400 IS

1 relevant data to NEMSIS or other appro2 priate State or private registries; and 

3 ‘‘(iv) potential modifications to the 

4 Medicare and Medicaid programs under ti5 tles XVIII and XIX, respectively, of the 

6 Social Security Act or other Federal health 

7 programs to provide appropriate reim8 bursement and financial incentives for field 

9 EMS agencies to develop or report relevant 

10 data to NEMSIS or other appropriate 

11 State or private registries. 

12 ‘‘(d) CLARIFICATION OF HIPAA.— 

13 ‘‘(1) EXCHANGE OF INFORMATION RELATED TO

14 THE TREATMENT OF PATIENTS.— 

15 ‘‘(A) IN GENERAL.—Nothing in HIPAA 

16 privacy and security law (as defined in section 

17 3009(a)(2)) shall be construed as prohibiting 

18 the exchange of information between field EMS 

19 practitioners treating an individual and per20 sonnel of a hospital to which the individual is 

21 transported for the purposes of relating infor22 mation on the medical history, treatment, care, 

23 and outcome of such individual (including any 

24 health care personnel safety issues such as in25 fectious disease). 


jbell on DSK4SPTVN1PROD with BILLS
39 

•S 2400 IS

1 ‘‘(B) GUIDELINES.—The Secretary shall 

2 establish guidelines for exchanges of informa3 tion between field EMS practitioners treating 

4 an individual and personnel of a hospital to 

5 which the individual is transported to protect 

6 the privacy of the individual while ensuring the 

7 ability of such EMS practitioners and hospital 

8 personnel to communicate effectively to further 

9 the continuity and quality of emergency medical 

10 care provided to such individual. 

11 ‘‘(2) NEMSIS DATA.—Nothing in HIPAA pri12 vacy and security law (as defined in section 

13 3009(a)(2)) shall be construed as prohibiting— 

14 ‘‘(A) a field EMS agency from submitting 

15 EMS data to the State EMS Office for the pur16 pose of quality improvement and data collection 

17 by the State for submission to NEMSIS; or 

18 ‘‘(B) the State EMS Office from submit19 ting aggregated nonindividually identifiable 

20 EMS data to the National EMS Database 

21 maintained by NHTSA. 

22 ‘‘SEC. 1295. FIELD EMS EDUCATION GRANTS. 

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

24 field EMS as a health profession and ensuring the avail25 ability, quality, and capability of field EMS educators, 


jbell on DSK4SPTVN1PROD with BILLS
40 

•S 2400 IS

1 practitioners, and medical directors, the Director may 

2 make grants to eligible entities for the development, avail3 ability, and dissemination of field EMS education pro4 grams and courses that improve the quality and capability 

5 of field EMS personnel. In carrying out this section, the 

6 Director shall take into consideration recommendations of 

7 the Administrators of each of NHTSA, FICEMS, and 

8 NEMSAC, the National Health Care Workforce Commis9 sion established under section 5101 of the Patient Protec10 tion and Affordable Care Act (42 U.S.C. 294q), and rel11 evant stakeholders. 

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

13 entity’ means an educational organization, an educational 

14 institution, a professional association, and any other entity 

15 involved with the education of field EMS practitioners. 

16 ‘‘(c) USE OF FUNDS.—The Director may award a 

17 grant to an eligible entity under paragraph (1) only if the 

18 entity agrees to use the grant to— 

19 ‘‘(1) develop and implement education programs 

20 that— 

21 ‘‘(A) train field EMS trainers and promote 

22 the adoption and implementation of the edu23 cation standards identified in the ‘Emergency 

24 Medical Services Education Agenda for the FuVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
41 

•S 2400 IS

1 ture: A Systems Approach’ including any revi2 sions thereto; 

3 ‘‘(B) bridge the gap in knowledge and 

4 skills in field EMS and among field EMS and 

5 other allied health professions to develop a larg6 er cadre of educational instructors and build a 

7 stronger and more flexible field EMS practi8 tioner corps; or 

9 ‘‘(C) provide training and retraining pro10 grams to provide displaced workers the oppor11 tunity to enter a field EMS profession; 

12 ‘‘(2) develop and implement educational courses 

13 pertaining to— 

14 ‘‘(A) instructor courses; 

15 ‘‘(B) provision of medical direction of field 

16 EMS; 

17 ‘‘(C) field EMS practitioners, including 

18 physicians, emergency medical technicians, 

19 paramedics, nurses, and other relevant clini20 cians providing emergency medical care in the 

21 field; 

22 ‘‘(D) field EMS educational and clinical re23 search; 

24 ‘‘(E) bridge programs among field EMS, 

25 nursing, and other allied health professions; 


jbell on DSK4SPTVN1PROD with BILLS
42 

•S 2400 IS

1 ‘‘(F) field EMS management; 

2 ‘‘(G) national, evidence-based guidelines; 

3 and 

4 ‘‘(H) translation of the lessons learned in 

5 military medicine to field EMS; 

6 ‘‘(3) evaluate education and training courses 

7 and methodologies to identify optimal educational 

8 modalities for field EMS practitioners; 

9 ‘‘(4) improve the field EMS education infra10 structure by increasing the number of field EMS in11 structors and the quality of their preparation by im12 proving, enhancing, and modernizing the dissemina13 tion of EMS education, including distance learning, 

14 and by establishing quality improvement for EMS 

15 education programs; 

16 ‘‘(5) enhance the opportunity for medical direc17 tion training and for promoting appropriate medical 

18 oversight of field emergency medical care; 

19 ‘‘(6) improve systems to design, implement, and 

20 evaluate education for prospective and current field 

21 EMS providers; or 

22 ‘‘(7) carrying out such other activities as the 

23 Director determines appropriate. 

24 ‘‘(d) PRIORITY.—The Director, in consultation with 

25 NHTSA and relevant stakeholders, and taking into conVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
43 

•S 2400 IS

1 sideration the recommendations of FICEMS and 

2 NEMSAC, shall establish a system of prioritization in 

3 awarding grants under this section to eligible entities. 

4 ‘‘(e) DURATION OF GRANTS.—Grants under this sec5 tion shall be for a period of 1 to 3 years. 

6 ‘‘(f) APPLICATION.—The Director may not award a 

7 grant to an eligible entity under this section unless the 

8 entity submits an application to the Director in such form, 

9 in such manner, and containing such agreements, assur10 ances, and information as the Director may require. The 

11 Director shall ensure that the requirements for submitting 

12 an application under this section are not unduly burden13 some. 

14 ‘‘SEC. 1296. EVALUATING INNOVATIVE MODELS FOR AC15 CESS AND DELIVERY OF FIELD EMS FOR PA16 TIENTS. 

17 ‘‘(a) EVALUATION.— 

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

19 the date of the enactment of the Field EMS Innova20 tion Act, the Director, in consultation with the Ad21 ministrator of the Centers for Medicare & Medicaid 

22 Services, and taking into consideration the rec23 ommendations of NEMSAC and FICEMS, shall 

24 complete an evaluation of— 


jbell on DSK4SPTVN1PROD with BILLS
44 

•S 2400 IS

1 ‘‘(A) the provision of and reimbursement 

2 for alternative delivery models for medical care 

3 through field EMS; and 

4 ‘‘(B) the integration of field EMS patients 

5 with other medical providers and facilities as 

6 medically appropriate. 

7 ‘‘(2) SPECIFIC ISSUES.—In completing the eval8 uation under paragraph (1), the Director shall con9 sider each of the following: 

10 ‘‘(A) Alternative dispositions of patients, 

11 including— 

12 ‘‘(i) transporting patients by ambu13 lance to destinations other than a hospital 

14 such as the office of the patient’s physi15 cian, an urgent care center, or the facilities 

16 of another health care provider; 

17 ‘‘(ii) when medically necessary, the 

18 evaluation, treatment, or referral of pa19 tients to other medically appropriate health 

20 care providers; 

21 ‘‘(iii) the provision of medical care re22 gardless of the decision to transport, such 

23 as reimbursement models based on readi24 ness rather than transport and shared sav25 ings; and 


jbell on DSK4SPTVN1PROD with BILLS
45 

•S 2400 IS

1 ‘‘(iv) the provision of health care 

2 using patient centered mobile resources in 

3 the out-of-hospital environment, such as 

4 mobile integrated health care services and 

5 community paramedicine. 

6 ‘‘(B) Issues related to medical liability and 

7 the requirements of section 1867 of the Social 

8 Security Act (42 U.S.C. 1395dd; commonly re9 ferred to as ‘EMTALA’) associated with trans10 port to destinations other than a hospital emer11 gency department. 

12 ‘‘(C) Necessary protections to ensure that 

13 patients receive timely and appropriate care in 

14 the appropriate setting. 

15 ‘‘(D) Whether there are any barriers to 

16 providing alternate dispositions to patients who 

17 are not in need of care in hospital emergency 

18 departments. 

19 ‘‘(E) Other issues determined by the Di20 rector, including, when practicable, issues rec21 ommended by FICEMS or NEMSAC for eval22 uation under this subsection. 

23 ‘‘(b) DEMONSTRATION PROJECTS.— 

24 ‘‘(1) IN GENERAL.—Beginning not later than 1 

25 year after the date of the enactment of the Field 


jbell on DSK4SPTVN1PROD with BILLS
46 

•S 2400 IS

1 EMS Innovation Act, the Director shall conduct or 

2 support at least 10 demonstration projects to— 

3 ‘‘(A) evaluate the implementation and re4 imbursement of alternative dispositions of field 

5 EMS patients, including— 

6 ‘‘(i) transporting patients by ambu7 lance to alternate destinations when medi8 cally appropriate and in the patients’ best 

9 interests; 

10 ‘‘(ii) when medically necessary, evalu11 ating, treating, or referring patients to 

12 other medically appropriate providers; and 

13 ‘‘(iii) when medically appropriate, 

14 treating patients through mobile integrated 

15 health care services or community 

16 paramedicine. 

17 ‘‘(B) evaluate the implementation of reim18 bursement models based on readiness rather 

19 than transport or shared savings; and 

20 ‘‘(C) determine whether such alternative 

21 dispositions and reimbursement models— 

22 ‘‘(i) improve the safety, effectiveness, 

23 timeliness, and efficiency of EMS; and 

24 ‘‘(ii) reduce overall utilization and ex25 penditures under the Medicare program 


jbell on DSK4SPTVN1PROD with BILLS
47 

•S 2400 IS

1 under title XVIII of the Social Security 

2 Act. 

3 ‘‘(2) EVIDENCE-BASED PROTOCOLS.—The Di4 rector shall ensure that at least one demonstration 

5 project under paragraph (1) evaluates evidence6 based protocols that give guidance on selection of 

7 the destination to which patients are transported. 

8 ‘‘(3) DURATION.—The period of a demonstra9 tion project under paragraph (1) shall not exceed 3 

10 years. 

11 ‘‘(4) RESEARCH.—The Director shall conduct 

12 or support further research that the Director deter13 mines to be necessary prior to or in conjunction with 

14 the demonstration projects under this subsection in 

15 order to evaluation the implementation of alternative 

16 dispositions of field EMS patients. 

17 ‘‘(5) FUNDING.—Of the amount made available 

18 to carry out section 1115A of the Social Security 

19 Act (42 U.S.C. 1315a) for a fiscal year, the Sec20 retary may transfer such sums as may be necessary 

21 to carry out this subsection. 

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

23 after the completion of all demonstration projects under 

24 subsection (b), the Director shall submit to Congress a 

25 report on the results of activities under this section, inVerDate Mar 15 2010 00:10 Jun 03, 2014 Jkt 039200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S2400.IS S2400

jbell on DSK4SPTVN1PROD with BILLS
48 

•S 2400 IS

1 cluding recommendations on the efficacy of alternative dis2 positions of field EMS patients.’’. 

3 SEC. 5. ENHANCING RESEARCH IN FIELD EMS. 

4 (a) MODELS TO BE TESTED BY CENTER FOR MEDI5 CARE AND MEDICAID INNOVATION.—Section 

6 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 

7 1315a(b)(2)(B)) is amended by adding at the end the fol8 lowing: 

9 ‘‘(xxi) Enhancing health outcomes for 

10 patients receiving field emergency medical 

11 services and improving timely and efficient 

12 delivery of high-quality field emergency 

13 medical services, such as through— 

14 ‘‘(I) regionalization of emergency 

15 care; 

16 ‘‘(II) medical transport to alter17 nate destinations; or 

18 ‘‘(III) when medically necessary, 

19 the evaluation, treatment, or referral 

20 of patients to other medically appro21 priate health providers.’’. 

22 (b) EMERGENCY MEDICAL RESEARCH.—Section 

23 498D of the Public Health Service Act (42 U.S.C. 289g– 

24 4) is amended— 


jbell on DSK4SPTVN1PROD with BILLS
49 

•S 2400 IS

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

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

3 (2) by inserting after subsection (b) the fol4 lowing: 

5 ‘‘(c) FIELD EMS EMERGENCY MEDICAL RE6 SEARCH.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall con8 duct research and evaluation relating to field EMS 

9 through the Agency for Healthcare Research and 

10 Quality and the Center for Medicare and Medicaid 

11 Innovation. 

12 ‘‘(2) DEFINITION.—In this subsection, the term 

13 ‘field EMS’ has the meaning given such term in sec14 tion 1291.’’. 

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

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

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

18 the following: 

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

20 ‘‘(a) ESTABLISHMENT.—The Director shall establish 

21 within the Office of Research and Evaluation a Field EMS 

22 Evidence-Based Practice Center (referred to in this sec23 tion as the ‘Center’). 

24 ‘‘(b) PURPOSE.—The purpose of the Center is to con25 duct or support research to promote the highest quality 


jbell on DSK4SPTVN1PROD with BILLS
50 

•S 2400 IS

1 of emergency medical care in field EMS and the most ef2 fective delivery system for the provision of such care, in3 cluding— 

4 ‘‘(1) comparative safety and effectiveness re5 search; 

6 ‘‘(2) other appropriate clinical or systems re7 search; and 

8 ‘‘(3) research addressing— 

9 ‘‘(A) critical care transport; 

10 ‘‘(B) off-shore operations; 

11 ‘‘(C) tactical emergency medical services; 

12 ‘‘(D) air medical services; and 

13 ‘‘(E) the application of lessons learned in 

14 military field medicine in the delivery of emer15 gency medical care in field EMS. 

16 ‘‘(c) DEFINITION.—In this section, the term ‘field 

17 EMS’ has the meaning given such term in section 1291.’’. 

18 (d) LIMITATIONS ON CERTAIN USES OF RE19 SEARCH.—Section 1182 of the Social Security Act (42 

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

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

22 Act or section 498D(c) or 938 of the Public Health Serv23 ice Act’’. 

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

25 research conducted pursuant to clause (xxi) of section 


jbell on DSK4SPTVN1PROD with BILLS
51 

•S 2400 IS

1 1115A(b)(2)(B) of the Social Security Act (as added by 

2 subsection (a)), subsection (c) of section 498D of the Pub3 lic Health Service Act (as added by subsection (b)), section 

4 938 of the Public Health Service Act (as added by sub5 section (c)), or any other research funded by the Depart6 ment of Health and Human Services related to emergency 

7 medical services in the field in which informed consent is 

8 required but may not be attainable, the Secretary of 

9 Health and Human Services shall— 

10 (1) evaluate and consider the patient and re11 search issues involved; and 

12 (2) address regulatory barriers to such research 

13 related to the need for informed consent in a man14 ner that ensures adequate patient safety and notifi15 cation, and submit recommendations to Congress for 

16 any changes to Federal statutes necessary to ad17 dress such barriers. 

18 SEC. 6. EMERGENCY MEDICAL SERVICES TRUST FUND. 

19 (a) DESIGNATION OF INCOME TAX OVERPAYMENTS

20 AND ADDITIONAL CONTRIBUTIONS FOR EMERGENCY

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

22 Internal Revenue Code of 1986 is amended by adding at 

23 the end the following new part: 


jbell on DSK4SPTVN1PROD with BILLS
52 

•S 2400 IS

1 ‘‘PART IX—DESIGNATION OF INCOME TAX OVER2 PAYMENTS AND ADDITIONAL CONTRIBU3 TIONS FOR EMERGENCY MEDICAL SERVICES 

4 ‘‘SEC. 6097. DESIGNATION BY INDIVIDUALS. 

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

6 nonresident alien) may designate that— 

7 ‘‘(1) a specified portion of any overpayment of 

8 tax for a taxable year, and 

9 ‘‘(2) any amount contributed in addition to any 

10 payment of tax for such taxable year and any des11 ignation under paragraph (1), 

12 shall be used to fund the Emergency Medical Services 

13 Trust Fund. Designations under the preceding sentence 

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

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

16 such other amount as the taxpayer designates. 

17 ‘‘(b) OVERPAYMENTS TREATED AS REFUNDED.— 

18 For purposes of this title, any portion of an overpayment 

19 of tax designated under subsection (a) shall be treated 

20 as— 

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

22 last date prescribed for filing the return of tax im23 posed by chapter 1 (determined without regard to 

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

25 and 


jbell on DSK4SPTVN1PROD with BILLS
53 

•S 2400 IS

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

2 such date to the United States. 

3 ‘‘(c) MANNER AND TIME OF DESIGNATION.—A des4 ignation under subsection (a) may be made with respect 

5 to any taxable year— 

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

7 imposed by chapter 1 for such taxable year, or 

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

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

10 taxable year) specified in regulations prescribed by 

11 the Secretary. 

12 Such designation shall be made in such manner as the 

13 Secretary prescribes by regulations except that, if such 

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

15 tax imposed by chapter 1 for such taxable year, such des16 ignation shall be made either on the first page of the re17 turn or on the page bearing the signature of the tax18 payer.’’. 

19 (b) EMERGENCY MEDICAL SERVICES TRUST

20 FUND.—Subchapter A of chapter 98 of the Internal Rev21 enue Code of 1986 is amended by adding at the end the 

22 following new section: 

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

24 ‘‘(a) CREATION OF TRUST FUND.—There is estab25 lished in the Treasury of the United States a trust fund 


jbell on DSK4SPTVN1PROD with BILLS
54 

•S 2400 IS

1 to be known as the ‘Emergency Medical Services Trust 

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

3 paid to such trust fund as provided in subsection (b). 

4 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here5 by appropriated to the Emergency Medical Services Trust 

6 Fund amounts equivalent to the amounts of the overpay7 ments of tax to which designations under section 6097 

8 apply. 

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

10 in the Emergency Medical Services Trust Fund shall be 

11 available, as provided in appropriation Acts, only for car12 rying out the provisions for which amounts are authorized 

13 to be appropriated under subsections (a) and (b) of section 

14 7 of the Field EMS Innovation Act.’’. 

15 (c) CLERICAL AMENDMENTS.— 

16 (1) CLERICAL AMENDMENT.—The table of 

17 parts for subchapter A of chapter 61 of the Internal 

18 Revenue Code of 1986 is amended by adding at the 

19 end the following new item: 

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

CONTRIBUTIONS FOR EMERGENCY MEDICAL SERVICES.’’. 

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

21 chapter 98 of such Code is amended by adding at 

22 the end the following new item: 

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


jbell on DSK4SPTVN1PROD with BILLS
55 

•S 2400 IS

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

2 this section shall apply to taxable years beginning after 

3 December 31, 2015. 

4 SEC. 7. AUTHORIZATION OF APPROPRIATIONS. 

5 (a) IN GENERAL.—Out of amounts in the Emergency 

6 Medical Services Trust Fund, there are authorized to be 

7 transferred— 

8 (1) to the Secretary of Health and Human 

9 Services— 

10 (A) $12,000,000, for the purpose of car11 rying out section 2831 of the Public Health 

12 Service Act (except for subsection (b)(3) of 

13 such section), section 1294 of such Act, and 

14 section 1296 of such Act (except for subsection 

15 (b) of such section) for each of fiscal years 

16 2015 through 2019; 

17 (B) $200,000,000 for each of fiscal years 

18 2015 through 2019, for the purpose of carrying 

19 out section 1292 of the Public Health Service 

20 Act; 

21 (C) $50,000,000 for each of fiscal years 

22 2015 through 2019, for the purpose of carrying 

23 out section 1293 of the Public Health Service 

24 Act; 


jbell on DSK4SPTVN1PROD with BILLS
56 

•S 2400 IS

1 (D) $15,000,000 for each of fiscal years 

2 2015 through 2019, for the purpose of carrying 

3 out section 1295 of the Public Health Service 

4 Act; and 

5 (E) $40,000,000 for each of fiscal years 

6 2015 through 2019, for the purpose of carrying 

7 out sections 498D(c) and 938 of the Public 

8 Health Service Act, as added by section 5; and 

9 (2) to the Secretary of Transportation, 

10 $4,000,000 for each of fiscal years 2015 through 

11 2019, for the purpose of carrying out section 

12 1292(c)(1) of the Public Health Service Act. 

13 (b) EXCESS AMOUNTS.—If, for any fiscal year, 

14 amounts in the Emergency Medical Services Trust Fund 

15 exceed the maximum amount authorized to be transferred 

16 under subsection (a), the Secretary of Health and Human 

17 Services may transfer such excess amounts for the purpose 

18 of carrying out section 330J, section 498D, and parts A, 

19 B, C, D, and H of title XII of the Public Health Service 

20 Act (42 U.S.C. 254c–15, 289g–4, 300d et seq., 300d–11 

21 et seq., 300d–31 et seq., and 300d–81 et seq.). 

22 (c) START-UP FUNDING.— 

23 (1) IN GENERAL.—Out of the discretionary 

24 funds available to the Secretary of Health and 

25 Human Services for each of fiscal years 2015 and 


jbell on DSK4SPTVN1PROD with BILLS
57 

•S 2400 IS

1 2016, $40,000,000 shall be used for carrying out the 

2 amendments made by subsections (a), (b), and (c) of 

3 section 5. 

4 (2) RELATION TO OTHER FUNDS.—The amount 

5 of discretionary funds allocated under paragraph (1) 

6 for the purpose of carrying out subsections (a), (b), 

7 and (c) of section 5 shall be in addition to, not in 

8 lieu of, the amount of discretionary funds that would 

9 otherwise be available for such purpose. 

10 (d) ADMINISTRATIVE EXPENSES.—Of the amounts 

11 made available under subsection (a), (b), or (c) to carry 

12 out each of the provisions listed in subsection (a), not 

13 more than 5 percent of each such amount may be used 

14 for Federal administrative expenses. 

15 SEC. 8. STATUTORY CONSTRUCTION. 

16 Nothing in this Act, including the amendments made 

17 by this Act shall be construed to supercede any statutory 

18 authority of any Federal agency that is not within the De19 partment of Health and Human Services. 

Æ 


jbell on DSK4SPTVN1PROD with BILLS