I 
113TH CONGRESS 
1ST SESSION 
H. R. 809 
To provide for improvement of field emergency medical services, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 25, 2013 
Mr. BUCSHON introduced the following bill; which was referred to the Com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Field EMS Quality, Innovation, and Cost Effectiveness 
Improvements Act of 2013’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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 HHS as primary Federal agency for emergency medical 
services and trauma care. 
Sec. 5. Field EMS Excellence, Quality, Universal Access, Innovation, and Pre-
paredness. 
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. Emergency Medical Services Trust Fund. 
Sec. 12. Authorization of appropriations. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) All persons throughout the country should 
have access to and receive high-quality emergency 
medical care as part of a coordinated emergency 
medical services system. 
(2) Properly functioning emergency medical 
services (EMS) systems, 24 hours per day, 7 days 
per week, are essential to ensure access to emer-
gency medical care and transport for all patients 
with emergency medical conditions. Such coordi-
nated EMS systems are also necessary for response 
to catastrophic incidents. 
(3) Ensuring high-quality and cost-effective 
EMS systems requires readiness, preparedness, med-
ical direction, oversight, and innovation throughout 
the continuum of emergency medical care through 
Federal, State, and local multijurisdictional collabo-
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ration and sufficient resources for EMS agencies 
and providers. 
(4) At the Federal level, EMS responsibilities 
and resources of several Federal agencies consistent 
with their expertise and authority must emphasize 
the critical importance of Federal agency collabora-
tion and coordination for all emergency medical serv-
ices. 
(5) At the State and local level, EMS systems 
and agencies require the coordination and improved 
capabilities of multiple and diverse stakeholders. 
(6) Emergency medical services encompass the 
provision of care provided to patients with emer-
gency medical conditions throughout the continuum, 
including emergency medical care and trauma care 
provided in the field, hospital, and rehabilitation set-
tings. 
(7) Field EMS comprises essential emergency 
medical services, including medical care or medical 
transport provided to patients prior to or outside 
medical facilities and other clinical settings. The pri-
mary purpose of field emergency medical services is 
to ensure that emergency medical patients receive 
the right care at the right place in the right amount 
of time. 
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(8) Coordinated and high-quality field EMS is 
essential to the Nation’s security. Field EMS is an 
essential public service provided by governmental 
and nongovernmental agencies and practitioners 24 
hours a day, 7 days a week, and during catastrophic 
incidents. To ensure disaster and all-hazards pre-
paredness for EMS operations as part of the Na-
tion’s comprehensive disaster preparedness, Federal 
funding for preparedness activities, including cata-
strophic training and drills, must be provided to gov-
ernmental and nongovernmental EMS agencies so as 
to ensure a greater capability within each of these 
areas. 
(9) Numerous recommendations from several 
significant national reports and documents have 
demonstrated the need in multiple areas for substan-
tial improvement of emergency medical services pro-
vided in the field, including recommendations in the 
EMS Agenda for the Future, the Institute of Medi-
cine report ‘‘The Future of Emergency Care in the 
United Health System’’, and the National EMS 
Education Agenda for the Future: A Systems Ap-
proach and recommendations by the National EMS 
Workforce Injury and Illness Surveillance Program, 
the Department of Transportation’s National EMS 
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Advisory Council (NEMSAC), and the Federal 
Interagency Committee on Emergency Medical Serv-
ices (FICEMS). 
(10) To substantially improve field EMS, ad-
vancements must be made in several essential areas 
including readiness, innovation, preparedness, edu-
cation and workforce development, safety, financing, 
quality, standards, and research. 
(11) The recognition of a primary pro-
grammatic Federal agency for emergency medical 
services within the Department of Health and 
Human Services was recommended by the Institute 
of Medicine and is necessary to provide a more 
streamlined, cost-efficient, and comprehensive ap-
proach for field EMS and a focal point for practi-
tioners and agencies to interface with the Federal 
Government. 
(12) The essential role of field EMS in disaster 
preparedness and response must be incorporated 
into the national preparedness and response strategy 
and implementation as provided and overseen by the 
Department of Homeland Security and the Depart-
ment of Health and Human Services pursuant to 
their respective jurisdictions. 
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(13) The essential role of NHTSA in the con-
tinued development of NEMSIS and in overseeing 
transportation issues related to field EMS such as 
EMS and ambulance vehicle safety standards should 
be maintained. 
(14) FICEMS must continue in its essential 
role in coordinating the Federal activities related to 
the full spectrum of EMS. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) The term ‘‘ambulance diversion’’ means the 
practice by hospitals of denying access to an incom-
ing ambulance by requesting it to proceed to another 
facility due to a stated lack of capacity at the initial 
facility, resulting in delayed access to definitive care. 
(2) The term ‘‘EMS’’ means emergency medical 
services. 
(3) The term ‘‘FICEMS’’ means the Federal 
Interagency Committee on Emergency Medical Serv-
ices. 
(4) The term ‘‘field EMS’’ means emergency 
medical services provided to patients (including 
transport by ground, air, or otherwise) prior to or 
outside a medical facility or other clinical setting. 
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(5) The term ‘‘field EMS agency’’ means an or-
ganization providing field EMS, regardless of— 
(A) whether such organization is govern-
mental, nongovernmental, or volunteer; and 
(B) whether such organization provides 
field EMS by ground, air, or otherwise. 
(6) The term ‘‘emergency medical services’’ or 
‘‘EMS’’ means emergency medical care, trauma 
care, and related services provided to patients at any 
point in the continuum of health care services, in-
cluding emergency medical dispatch and emergency 
medical care, trauma care, and related services pro-
vided in the field, during transport, or in a medical 
facility or other clinical setting. 
(7) The term ‘‘field EMS patient care reports’’ 
means the information that a field EMS agency 
typically creates regarding a patient’s medical condi-
tion and treatment in the course of providing emer-
gency medical services to that patient. 
(8) The term ‘‘medical oversight’’ means the 
supervision by a physician of the medical aspects of 
an EMS system or agency and its providers includ-
ing prospective, concurrent, and respective compo-
nents of field EMS and the education of EMS pro-
viders. 
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(9) The term ‘‘NEMSAC’’ means the National 
Emergency Medical Services Advisory Council. 
(10) The term ‘‘NEMSIS’’ means the National 
EMS Information System. 
(11) The term ‘‘NHTSA’’ means the National 
Highway Traffic Safety Administration. 
(12) The term ‘‘patient parking’’ means the 
practice by hospitals of refusing to accept transfer 
of a patient’s care from an ambulance crew until a 
regular emergency department bed is available, re-
quiring the crew to continue to provide patient care 
on the ambulance stretcher other than a patient bed 
in the hospital until hospital staff will accept the 
transfer of care, resulting in delayed access to defin-
itive care. 
(13) The term ‘‘State EMS Office’’ means an 
office designated by the State with primary responsi-
bility for oversight of the State’s EMS system, such 
as responsibility for oversight of EMS coordination, 
licensing or certifying EMS practitioners, and EMS 
system improvement. 
(14) The term ‘‘STEMI’’ means ST–Segment 
Elevation Myocardial Infarction. 
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SEC. 4. RECOGNITION OF HHS AS PRIMARY FEDERAL 
AGENCY FOR EMERGENCY MEDICAL SERV-
ICES AND TRAUMA CARE. 
(a) PRIMARY FEDERAL AGENCY.—The Department 
of Health and Human Services shall serve as the primary 
Federal agency with responsibility for programs and ac-
tivities relating to emergency medical services and trauma 
care. 
(b) OFFICE OF EMS AND TRAUMA.— 
(1) ESTABLISHMENT.—There is established an 
Office of Emergency Medical Services and Trauma, 
to be known as the Office of EMS and Trauma, 
within the Department of Health and Human Serv-
ices. The Office of EMS and Trauma shall be head-
ed by a director appointed by the Secretary of 
Health and Human Services. 
(2) ROLE OF OFFICE WITHIN HHS.— 
(A) IN GENERAL.—The Office of EMS and 
Trauma shall have— 
(i) the responsibilities delegated to the 
Office of EMS and Trauma pursuant to 
paragraph (3); 
(ii) the responsibilities and authorities 
vested in the Office of EMS and Trauma 
by other provisions of this Act; and 
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(iii) such responsibilities and authori-
ties as may be delegated or transferred to 
the Office of EMS and Trauma pursuant 
to subparagraph (B). 
(B) ADDITIONAL
RESPONSIBILITIES
AND 
AUTHORITIES.—In addition to the responsibil-
ities and authorities specified in clauses (i) and 
(ii) of subparagraph (A), the Secretary of 
Health and Human Services may delegate or 
transfer to the Office of EMS and Trauma any 
other responsibility or authority of the Depart-
ment of Health and Human Services relating to 
emergency medical services and trauma care, 
including such services and care relating to— 
(i) the full continuum of emergency 
medical services, including field EMS and 
trauma and hospital emergency medical 
care; or 
(ii) improving the quality, innovation, 
or cost effectiveness of emergency medical 
services. 
(C) LOCATION OF OFFICE IN HHS.—The 
Secretary shall locate the Office of EMS and 
Trauma within the organizational structure of 
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the Department of Health and Human Services 
in a manner that achieves each of the following: 
(i) Recognition of the importance and 
unique life-saving services associated with 
field EMS, trauma care, and hospital 
emergency care as a significant Federal 
priority. 
(ii) Integration of these essential serv-
ices with the larger health care system and 
within the disaster preparedness system, 
including through regionalization of such 
services and by enhancing daily readiness 
capabilities to ensure adequate disaster 
readiness capabilities, consistent with the 
National Health Security Strategy. 
(iii) Consolidation, co-location, and 
cost efficiencies in administering programs 
and activities related to field EMS, trauma 
care, and hospital emergency medical care. 
(iv) Establishment of a Federal focal 
point for leadership and improved coordi-
nation, support, and oversight of field 
EMS, trauma care and hospital emergency 
medical care. 
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(v) Sufficient level and stature such 
that— 
(I) such Office is able to fulfill its 
role, responsibilities, and authorities; 
and 
(II) the Director of such Office 
reports directly to the Secretary or an 
official within the Department who re-
ports directly to the Secretary. 
(vi) Establishment of a visible and 
identifiable point of contact with which the 
public; EMS agencies and practitioners; 
State and local government agencies; EMS 
educational institutions; EMS, trauma, 
and hospital emergency care professional 
associations; and all other parties may 
interact. 
(3) 
RESPONSIBILITIES.—The 
Secretary 
of 
Health and Human Services shall, at a minimum, 
delegate responsibility to the Office of EMS and 
Trauma to carry out— 
(A) sections 5 and 6 (relating to the 
EQUIP and SPIA grant programs, respec-
tively); 
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(B) section 330J of the Public Health 
Service Act (42 U.S.C. 254c–15; relating to 
rural emergency service training and equipment 
assistance program); 
(C) part A (42 U.S.C. 300d et seq.), part 
B (42 U.S.C. 300d–11 et seq.), part C (42 
U.S.C. 300d–31 et seq.), part D (42 U.S.C. 
300d–41 et seq.), and part H (42 U.S.C. 300d– 
81 et seq.) of title XII of the Public Health 
Service Act (relating to trauma care); 
(D) section 8 (relating to the field EMS 
education grant program); and 
(E) section 9 (relating to evaluating inno-
vative models for access and delivery of field 
EMS for patients). 
(c) NATIONAL EMS STRATEGY.—The Secretary of 
Health and Human Services, acting through the Director 
of the Office of EMS and Trauma, and in consultation 
with the Assistant Secretary for Preparedness and Re-
sponse and the Administrator of the Health Resources and 
Services Administration, shall develop and implement a 
cohesive national EMS strategy to strengthen the develop-
ment of the full continuum of EMS at the Federal, State, 
and local levels. In establishing such a strategy, the Sec-
retary shall— 
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(1) solicit and consider the recommendations of 
the NEMSAC as well as relevant stakeholders; 
(2) consult and collaborate with FICEMS to 
ensure consistency of such national EMS strategy 
within the larger Federal strategy regarding all of 
emergency medical services and national prepared-
ness and response; 
(3) address issues related to EMS patient and 
practitioner safety, standardization of EMS practi-
tioner licensing and credentialing, field EMS quality 
and medical oversight, regionalization of field EMS 
and trauma and emergency care services, availability 
of field EMS and trauma care and emergency med-
ical services throughout the Nation, and integration 
of field EMS practitioners into the broader health 
care system, including— 
(A) promotion of the adoption by States of 
the education standards identified in the 
‘‘Emergency Medical Services Education Agen-
da for the Future: A Systems Approach’’ and 
any revisions thereto, including the standardiza-
tion of licensing and credentialing of field EMS 
practitioners and standards of care, based on 
best practices and evidence-based medicine, in-
cluding by— 
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(i) the identification of differences in 
the levels of care, scope of practice, and li-
censure and credentialing requirements 
among the States; and 
(ii) the adoption by the States of na-
tional standards for such levels of care, 
scope of practice and licensure and 
credentialing requirements; 
(B) promotion of a culture of safety, in-
cluding— 
(i) the adoption of an anonymous 
error reporting system designed to identify 
systemic problems in field EMS patient 
and practitioner safety and ensure a single 
means of collecting and reporting relevant 
error data by field EMS agencies and 
States; 
(ii) the establishment of field EMS 
patient and practitioner safety goals and 
the specific means to improve field EMS 
practitioner and patient safety to achieve 
such goals; and 
(iii) the adoption of more uniform na-
tional ambulance vehicle safety and manu-
facturing standards as developed by the 
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National Fire Protection Administration or 
coordinated by NHTSA; 
(C) the integration and utilization of field 
EMS practitioners as part of the larger health 
care system including— 
(i) the potential utilization of field 
EMS practitioners for the provision of care 
to patients with nonemergent medical con-
ditions; and 
(ii) strategies to implement the rec-
ommendations provided by the National 
Health Care Workforce Commission, pur-
suant to section 5101(d)(2) of the Patient 
Protection and Affordable Care Act (42 
U.S.C. 294q(d)(2); and 
(D) such other issues as the Secretary con-
siders appropriate; 
(4) incorporate into such strategy the prepared-
ness and response objectives identified by the Sec-
retary of Homeland Security and the Assistant Sec-
retary for Preparedness and Response in order— 
(A) to ensure the capability and capacity 
of the full spectrum of EMS to respond to ter-
rorist attacks, disasters, catastrophic events, 
and mass casualty events; and 
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(B) to coordinate with the Secretary of 
Homeland Security accordingly; 
(5) complete the development of such strategy 
not later than 18 months after the date of enact-
ment of this Act; 
(6) communicate such strategy to the relevant 
congressional committees of jurisdiction; 
(7) implement such strategy to the extent prac-
tical not later than 3 years after the date of enact-
ment of this Act; and 
(8) update such strategy not less than every 3 
years. 
(d) STATUTORY CONSTRUCTION.—Nothing in this 
Act shall be construed to supercede any statutory author-
ity of any Federal agency that is not within the Depart-
ment of Health and Human Services. 
SEC. 5. FIELD EMS EXCELLENCE, QUALITY, UNIVERSAL AC-
CESS, INNOVATION, AND PREPAREDNESS. 
(a) IN GENERAL.—The Director of the Office of 
EMS and Trauma (in this section referred to as the ‘‘Di-
rector’’), shall establish the EQUIP grant program— 
(1) to promote excellence in all aspects of the 
provision of field EMS by field EMS agencies; 
(2) to enhance the quality of emergency medical 
care provided to patients by field EMS practitioners 
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through evidence-based, medically directed field 
emergency care; 
(3) to promote universal access to and avail-
ability of high-quality field EMS in all geographic lo-
cations of the Nation; 
(4) to spur innovation in the delivery of field 
EMS; and 
(5) to improve EMS agency readiness and pre-
paredness for day-to-day emergency medical re-
sponse. 
(b) APPLICATION.— 
(1) IN GENERAL.—To be eligible to receive a 
grant under this section, an eligible entity shall sub-
mit an application to the Director in such form and 
manner, that contains such agreements, assurances, 
and information as the Director determines to be 
reasonably necessary to carry out this section. 
(2) SIMPLE FORM.—The Director shall ensure 
that grant application requirements are not unduly 
burdensome to smaller and volunteer field EMS 
agencies or other agencies with limited resources. 
(3) 
CONSISTENCY
WITH
PREPARATION 
GOALS.—The Director shall ensure that grant appli-
cations are consistent with national and relevant 
State preparedness plans and goals. 
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(c) USE OF FUNDS.—Grants may be used by eligible 
entities to— 
(1) sustain field EMS practitioners to ensure 
24 hours a day, 7 days a week readiness and pre-
paredness at the local level; 
(2) develop and implement initiatives related to 
delivery of medical services, including— 
(A) innovative clinical practices to improve 
the cost effectiveness and quality of care deliv-
ered to emergency patients in the field that re-
sults in improved patient outcomes and cost 
savings to the health system, including for high 
prevalence emergency medical conditions such 
as sudden cardiac arrest, STEMI, stroke, and 
trauma; and 
(B) delivery systems to improve patient 
outcomes, which may include implementing evi-
dence-based protocols, interventions, systems, 
and technologies to reduce clinically meaningful 
response times; 
(3) purchase and implement— 
(A) medical equipment and training for 
using such equipment; 
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(B) communication systems to ensure 
seamless and interoperable communications 
with other first responders; and 
(C) information systems to comply with 
NEMSIS data collection and integrate field 
emergency care with electronic medical records; 
(4) participate in federally sponsored field EMS 
research; 
(5) establish or enhance comprehensive medical 
oversight and quality assurance programs that in-
clude the active participation by medical directors in 
field EMS medical direction and educational pro-
grams; and 
(6) such other uses as the Director may estab-
lish. 
(d) ADMINISTRATION OF GRANTS.—In establishing 
and administering the EQUIP grant program, the Direc-
tor— 
(1) shall establish a grantmaking process that 
includes— 
(A) prioritization for the awarding of 
grants to eligible entities and consideration of 
the factors in reviewing grant applications by 
eligible entities including— 
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(i) demonstrated financial need for 
funding; 
(ii) utilization of public and private 
partnerships; 
(iii) enhanced access to high-quality 
field EMS in under served geographic 
areas; 
(iv) unique needs of volunteer and 
rural field EMS agencies; 
(v) distribution among a variety of ge-
ographic areas, including urban, suburban, 
and rural; 
(vi) distribution of funds among types 
of EMS agencies, including governmental, 
nongovernmental and volunteer; 
(vii) implementation of evidence-based 
interventions that improve quality of care, 
patient outcomes, efficiency, or cost effec-
tiveness; and 
(viii) such other factors as the Direc-
tor considers necessary; 
(B) a peer-reviewed process to recommend 
grant allocations in accordance with the 
prioritization established by the Director except 
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that final award determinations shall be made 
by the Director; and 
(C) the provision of grant awards to eligi-
ble entities on an annual basis, except that the 
Director may reserve not more than 25 percent 
of the available appropriations for multiyear 
grants and no grant award may exceed a 2-year 
period; 
(2) shall consult with and take into consider-
ation the recommendations of the Assistant Sec-
retary for Preparedness and Response, FICEMS, 
NEMSAC and relevant stakeholders; 
(3) shall ensure that funds used for day-to-day 
preparedness activities are consistent and aligned 
with Federal preparedness priorities; and 
(4) may contract with an independent, third- 
party, nonprofit organization to administer the grant 
program if the Director establishes conflict-of-inter-
est requirements as part of any such contractual re-
lationship. 
(e) ELIGIBILITY.—Eligible grant recipients are field 
EMS agencies that— 
(1) are licensed by or otherwise authorized in 
the State in which they operate; and 
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(2) have medical oversight and quality improve-
ment programs as defined by the Director. 
(f) ANNUAL REPORT.—The Director shall submit an 
annual report on the EQUIP grant program under this 
section to the Congress. 
SEC. 6. FIELD EMS SYSTEM PERFORMANCE, INTEGRATION, 
AND ACCOUNTABILITY. 
(a) IN GENERAL.—The Director of the Office of 
EMS and Trauma (in this section referred to as the ‘‘Di-
rector’’) shall establish the SPIA grant program— 
(1) to improve field EMS system performance, 
integration and accountability; 
(2) to ensure preparedness for field EMS at the 
State and local levels; 
(3) to enhance physician medical oversight of 
field EMS systems; 
(4) to improve coordination between regional 
field EMS systems and integration of such regional 
field EMS systems into the larger health care sys-
tem; 
(5) to enhance data collection and analysis to 
improve, on a continuing basis, the field EMS sys-
tem; and 
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(6) to promote standardization of national EMS 
certification of emergency medical technicians and 
paramedics. 
(b) USE OF FUNDS.—Grants may be used by eligible 
entities— 
(1) to enhance EMS system readiness and pre-
paredness for day-to-day emergency medical re-
sponse; 
(2) to improve cross-border collaboration and 
planning among States; and 
(3) to collect data with regard to— 
(A) NEMSIS; 
(B) field EMS education; 
(C) field EMS workforce; 
(D) cardiac events, including STEMI and 
sudden cardiac arrest; 
(E) stroke; 
(F) disasters, including injuries and ill-
nesses; 
(G) ambulance diversion and patient park-
ing; 
(H) trauma (in a manner that is com-
plementary and not duplicative of other trauma 
data collection such as the National Trauma 
Data Bank); 
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(I) data determined necessary by the State 
office of EMS for oversight and coordination of 
the State field EMS system; and 
(J) any other such data that the Director 
specifies; 
(4) to implement and evaluate system-wide 
quality improvement initiatives, including medical di-
rection at the State, local, and regional levels; 
(5) to integrate field EMS with other health 
care services as part of a coordinated system of care 
provided to patients with emergency medical condi-
tions to help ensure the right patient receives the 
right care by the right crew in the right vehicle and 
at the right medical facility in the right amount of 
time, including by enhancing regional emergency 
medical dispatch; 
(6) to incorporate national EMS certification 
for all levels of emergency medical technicians and 
paramedics; 
(7) to improve the State’s planning for ensuring 
a consistent, available EMS workforce; 
(8) to fund EMS regional and local oversight 
and planning organizations or develop regional sys-
tems of emergency medical care within the State to 
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further enhance coordination and systemic develop-
ment throughout the State; and 
(9) for such other uses as the Director may es-
tablish. 
(c) ADMINISTRATION OF GRANTS.—In establishing 
and administering the SPIA grant program, the Director 
shall— 
(1) establish State EMS system performance 
standards to serve as guidance to States in improv-
ing their EMS systems and in applying for grants 
under this subsection. In establishing such stand-
ards, the Director shall— 
(A) take into the consideration the rec-
ommendations of the Assistant Secretary for 
Preparedness 
and 
Response, 
FICEMS, 
NEMSAC, and relevant stakeholders; 
(B) include national, evidence-based guide-
lines; and 
(C) take into account the needs and re-
source limitations of volunteer, smaller agen-
cies, and agencies in rural areas. 
(2) provide technical assistance to State EMS 
offices in conducting comprehensive EMS planning 
with regard to evidence-based workforce and devel-
opment competencies for field EMS management; 
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(3) allocate, within the available funds, SPIA 
grants to a maximum of one grant per applicant ac-
cording to a formula based on population and geo-
graphic area, as determined by the Director, for a 
period not to exceed 2 years; and 
(4) require that States allocate a portion of 
their grant funds to regional and local oversight and 
planning EMS organizations within the State for the 
purpose of field EMS system development, mainte-
nance, and improvement of coordination among re-
gional organizations. 
(d) APPLICATION.—To be eligible to receive a grant 
under this section, an eligible entity shall submit an appli-
cation to the Director in such form and manner, that con-
tains such agreements, assurances, and information as the 
Director determines to be reasonably necessary to carry 
out this section. 
(e) ELIGIBILITY.—The eligible entities for a grant 
under this section are the State EMS office in each of 
the several States, tribes, and territories. 
(f) ANNUAL REPORT.—The Director shall submit an 
annual report on the SPIA grant program under this sec-
tion to the Congress. 
SEC. 7. FIELD EMS QUALITY. 
(a) MEDICAL OVERSIGHT.— 
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(1) IN
GENERAL.—To improve medical over-
sight of field EMS and ensure continuity and quality 
for such medical oversight, the Director of the Office 
of EMS and Trauma (in this section referred to as 
the ‘‘Director’’) shall— 
(A) promote high-quality and comprehen-
sive medical oversight of— 
(i) all medical care provided by field 
EMS practitioners; and 
(ii) the education and training of field 
EMS practitioners; 
(B) promote the development, adoption, 
and utilization of national guidelines for the 
roles of physicians who provide medical over-
sight for field EMS and other health care pro-
viders who support physicians in this role; 
(C) support efforts of relevant physician 
stakeholders in developing and disseminating 
guidelines for use by EMS medical directors 
and field EMS practitioners on a national basis; 
and 
(D) convene a Field EMS Medical Over-
sight Advisory Committee, comprised of rep-
resentatives of relevant physician stakeholders, 
to advise the Director on ways and means to 
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advance and support development and mainte-
nance of quality medical oversight throughout 
the Nation’s systems for field EMS. 
(2) ADDITIONAL
CONSIDERATIONS.—In car-
rying out subparagraphs (B) and (C) of paragraph 
(1) (relating to supporting guidelines), the Director 
shall take into consideration— 
(A) existing guidelines developed by na-
tional 
professional 
physician 
associations, 
States, and other relevant governmental or non-
governmental entities; 
(B) the input of other relevant stake-
holders, including health care providers who 
support physicians who provide medical over-
sight for field EMS; and 
(C) the unique needs associated with med-
ical oversight of provision of field EMS in rural 
areas or by volunteers. 
(3) FLEXIBILITY.—The guidelines promoted 
under subparagraphs (B) and (C) of paragraph (1) 
shall ensure high-quality training, credentialing, and 
direction in connection with medical oversight of 
field EMS at the State, regional, and local levels 
while providing sufficient flexibility to account for 
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historical and legitimate differences in field EMS 
among States, regions, and localities. 
(4) REQUIRED USE OF GUIDELINES.—As a con-
dition on receipt of a grant under section 5 or 6, the 
Director shall require the grant recipient to adopt 
and implement (to the extent applicable) the guide-
lines promoted under subparagraphs (B) and (C) of 
paragraph (1). 
(b) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall complete a study on— 
(A) medical and administrative liability 
issues that may impede— 
(i) medical direction provided by phy-
sicians directly regarding specific patients 
or medical oversight provided by physicians 
in establishing medical protocols, proce-
dures, and other activities related to the 
provision of emergency medical care in 
field EMS; or 
(ii) the highest quality emergency 
medical care in field EMS provided by per-
sonnel other than physicians such as emer-
gency medical technicians and paramedics; 
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(B) reimbursement for any component of 
medical oversight; and 
(C) such other issues as the Comptroller 
General deems appropriate relating to improv-
ing the quality and medical oversight of emer-
gency medical care in field EMS. 
(2) REPORT TO CONGRESS.—Not later than 18 
months after the date of the enactment of this Act, 
the Comptroller General shall complete the study 
under paragraph (1) and submit a report to the 
Congress on the results of such study, including any 
recommendations. 
(c) DATA COLLECTION AND EXCHANGE.— 
(1) NATIONAL EMS INFORMATION SYSTEM.— 
(A) IN GENERAL.—The Administrator of 
NHTSA may maintain, improve, and expand 
the National EMS Information System, includ-
ing the National EMS Database. 
(B) CONSULTATION.—The Administrator 
of NHTSA shall carry out this paragraph in 
consultation with the Director. 
(C) STANDARDIZATION.—In carrying out 
subparagraph 
(A), 
the 
Administrator 
of 
NHTSA shall promote the collection and re-
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porting of data on field EMS in a standardized 
manner. 
(D) AVAILABILITY OF DATA.—The Admin-
istrator of NHTSA shall ensure that informa-
tion in the National EMS Database (other than 
individually identifiable information) is available 
to Federal and State policymakers, EMS stake-
holders, and researchers. 
(E) TECHNICAL ASSISTANCE.—In carrying 
out subparagraph (A), the Administrator of 
NHTSA may provide technical assistance to 
State and local agencies, field EMS agencies, 
and other entities deemed appropriate by the 
Administrator to assist in the collection, anal-
ysis, and reporting of data. 
(2) REPORT ON DATA GAPS.— 
(A) IN
GENERAL.—Not later than 12 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices, acting through the Director, in consulta-
tion with the Administrator of NHTSA, shall 
submit to the Congress a report that— 
(i) identifies gaps in the collection of 
data related to the provision of field EMS; 
and 
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(ii) includes recommendations for im-
proving the collection, reporting, and anal-
ysis of such data. 
(B) 
RECOMMENDATIONS.—The 
rec-
ommendations required by subparagraph (A)(ii) 
shall— 
(i) take into consideration the rec-
ommendations of FICEMS and NEMSAC 
and relevant stakeholders; 
(ii) recommend methods for improving 
data collection and reporting and analysis 
without unduly burdening reporting enti-
ties and without duplicating existing data 
sources (such as data collected by the Na-
tional Trauma Data Bank); 
(iii) address the quality and avail-
ability of data, and linkages with existing 
patient registries, related to the provision 
of field EMS and utilization of field EMS 
with respect to a variety of illnesses and 
injuries (in both the everyday provision of 
field EMS and catastrophic or disaster re-
sponse) including— 
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(I) cardiac events such as chest 
pain, sudden cardiac arrest, and 
STEMI; 
(II) stroke; 
(III) trauma; 
(IV) disaster and catastrophic in-
cidents, such as incidents related to 
terrorism or natural or manmade dis-
asters; and 
(V) ambulance diversion and pa-
tient parking; and 
(iv) include an analysis of the variety 
of services provided by field EMS agencies. 
(3) REPORT ON DATA INTEGRATION TO PRO-
MOTE
QUALITY
OF
CARE.—Not later than 18 
months after the date of the enactment of this Act, 
the Secretary of Health and Human Services, acting 
through the head of the Office of the National Coor-
dinator for Health Information Technology, in col-
laboration with the Director of the Office of EMS 
and Trauma, FICEMS, and the Administrator of 
NHTSA as appropriate, and taking into consider-
ation input from relevant stakeholders, shall submit 
a report (including recommendations) on issues, im-
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pediments, and potential solutions pertaining to the 
following objectives: 
(A) Incorporation of field EMS patient 
care reports into patient electronic health 
records, taking into consideration— 
(i) the extent to which field EMS pa-
tient care reports are presently created in 
electronic format and the potential for ele-
ments of such reports to be incorporated 
into patient electronic health records; 
(ii) the data elements of field EMS 
patient care reports that would promote 
quality and efficiency of care if incor-
porated into patient electronic health 
records; 
(iii) potential modifications to the 
Medicare and Medicaid programs under ti-
tles XVIII and XIX, respectively, of the 
Social Security Act or other Federal health 
programs (including potential modifica-
tions to the HITECH Act (title XIII of di-
vision A of Public Law 111–5) including 
modifications to the entities included as el-
igible for incentive payments under section 
1848(o), 1853(l) (to the extent that such 
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section 1848(o) is applied), or 1903(t) of 
the Social Security Act, criteria for cer-
tified EHR technology for purposes of 
such sections, and objectives and measures 
for determining meaningful use of such 
technology for purposes of such sections) 
to provide appropriate reimbursement and 
financial incentives for EMS agencies— 
(I) to maintain field EMS patient 
care reports in a structured electronic 
format; and 
(II) to otherwise adopt and use 
electronic health records; and 
(iv) potential modifications to the 
HITECH Act to provide incentives to eligi-
ble 
hospitals 
under 
section 
1886(n), 
1853(m) (to the extent that such section 
1886(n) is applied), or section 1814(l)(3) 
of the Social Security Act to incorporate 
appropriate data elements of field EMS 
patient care reports into patient electronic 
health records. 
(B) Incorporation of patient health infor-
mation created subsequent to the receipt of 
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field EMS emergency care into NEMSIS, tak-
ing into consideration— 
(i) what types of medical information 
created subsequent to the receipt of field 
EMS emergency care (such as outcomes 
information or information regarding sub-
sequent care and treatment) would, if in-
cluded in NEMSIS, be potentially useful in 
evaluating and improving the quality of 
EMS care; 
(ii) how best to integrate such infor-
mation into NEMSIS; 
(iii) potential modifications to the 
HITECH Act to require eligible hospitals, 
as defined in section 1886(n)(6)(B) of the 
Social Security Act, for purposes of incen-
tive payments under 1886(b)(3)(B)(ix) and 
1886(n) of such Act, to develop or report 
relevant data to NEMSIS or other appro-
priate State or private registries; and 
(iv) potential modifications to the 
Medicare and Medicaid programs under ti-
tles XVIII and XIX, respectively, of the 
Social Security Act or other Federal health 
programs to provide appropriate reim-
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bursement and financial incentives for field 
EMS agencies to develop or report relevant 
data to NEMSIS or other appropriate 
State or private registries. 
(d) CLARIFICATION OF HIPAA.— 
(1) EXCHANGE OF INFORMATION RELATED TO 
THE TREATMENT OF PATIENTS.— 
(A) IN GENERAL.—Nothing in HIPAA pri-
vacy and security law (as defined in section 
3009(a)(2) of the Public Health Service Act (42 
U.S.C. 300jj–19(a)(2)) shall be construed as 
prohibiting the exchange of information between 
field EMS practitioners treating an individual 
and personnel of a hospital to which the indi-
vidual is transported for the purposes of relat-
ing information on the medical history, treat-
ment, care, and outcome of such individual (in-
cluding any health care personnel safety issues 
such as infectious disease). 
(B) 
GUIDELINES.—The 
Secretary 
of 
Health and Human Services shall establish 
guidelines for exchanges of information between 
field EMS practitioners treating an individual 
and personnel of a hospital to which the indi-
vidual is transported to protect the privacy of 
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the individual while ensuring the ability of such 
EMS practitioners and hospital personnel to 
communicate effectively to further the con-
tinuity and quality of emergency medical care 
provided to such individual. 
(2) NEMSIS DATA.—Nothing in HIPAA pri-
vacy and security law (as defined in section 
3009(a)(2) of the Public Health Service Act (42 
U.S.C. 300jj–19(a)(2)) shall be construed as prohib-
iting— 
(A) a field EMS agency from submitting 
EMS data to the State EMS Office for the pur-
pose of quality improvement and data collection 
by the State for submission to NEMSIS; or 
(B) the State EMS Office from submitting 
aggregated nonindividually identifiable EMS 
data to the National EMS Database maintained 
by NHTSA. 
SEC. 8. FIELD EMS EDUCATION GRANTS. 
(a) IN GENERAL.—For the purpose of promoting 
field EMS as a health profession and ensuring the avail-
ability, quality, and capability of field EMS educators, 
practitioners, and medical directors, the Director of the 
Office of EMS and Trauma (in this section referred to 
as the ‘‘Director’’) may make grants to eligible entities 
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for the development, availability, and dissemination of 
field EMS education programs and courses that improve 
the quality and capability of field EMS personnel. In car-
rying out this section, the Director shall take into consid-
eration input from the Administrator of NHTSA, 
FICEMS, NEMSAC, the National Health Care Workforce 
Commission established under section 5101 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 294q), and 
relevant stakeholders. 
(b) ELIGIBILITY.—In this section, the term ‘‘eligible 
entity’’ means an educational organization, an educational 
institution, a professional association, and any other entity 
involved with the education of field EMS practitioners. 
(c) USE OF FUNDS.—The Director may award a 
grant to an eligible entity under paragraph (1) only if the 
entity agrees to use the grant to— 
(1) develop and implement education programs 
that— 
(A) train field EMS trainers and promote 
the adoption and implementation of the edu-
cation standards identified in the ‘‘Emergency 
Medical Services Education Agenda for the Fu-
ture: A Systems Approach’’ including any revi-
sions thereto; 
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(B) bridge the gap in knowledge and skills 
in field EMS and among field EMS and other 
allied health professions to develop a larger 
cadre of educational instructors and build a 
stronger and more flexible field EMS practi-
tioner corps; or 
(C) provide training and retraining pro-
grams to provide displaced workers the oppor-
tunity to enter a field EMS profession; 
(2) develop and implement educational courses 
pertaining to— 
(A) instructor courses; 
(B) provision of medical direction of field 
EMS; 
(C) field EMS practitioners, including phy-
sicians, emergency medical technicians, para-
medics, nurses, and other relevant clinicians 
providing emergency medical care in the field; 
(D) field EMS educational and clinical re-
search; 
(E) bridge programs among field EMS, 
nursing, and other allied health professions; 
(F) field EMS management; 
(G) national, evidence-based guidelines; 
and 
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(H) translation of the lessons learned in 
military medicine to field EMS; 
(3) evaluate education and training courses and 
methodologies to identify optimal educational modal-
ities for field EMS practitioners; 
(4) improve the field EMS education infrastruc-
ture by increasing the number of field EMS instruc-
tors and the quality of their preparation by improv-
ing, enhancing, and modernizing the dissemination 
of EMS education, including distance learning, and 
by establishing quality improvement for EMS edu-
cation programs; 
(5) enhance the opportunity for medical direc-
tion training and for promoting appropriate medical 
oversight of field emergency medical care; 
(6) improve systems to design, implement, and 
evaluate education for prospective and current field 
EMS providers; or 
(7) carrying out such other activities as the Di-
rector may identify. 
(d) PRIORITY.—The Director, in consultation with 
NHTSA and relevant stakeholders, and taking into con-
sideration 
the 
recommendations 
of 
FICEMS 
and 
NEMSAC, shall establish a system of prioritization in 
awarding grants under this section to eligible entities. 
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(e) DURATION OF GRANTS.—Grants under this sec-
tion shall be for a period of 1 to 3 years. 
(f) APPLICATION.—The Director may not award a 
grant to an eligible entity under this section unless the 
entity submits an application to the Director in such form, 
in such manner, and containing such agreements, assur-
ances, and information as the Director may require. The 
Director shall ensure that the requirements for submitting 
an application under this section are not unduly burden-
some. 
SEC. 9. EVALUATING INNOVATIVE MODELS FOR ACCESS 
AND DELIVERY OF FIELD EMS FOR PATIENTS. 
(a) EVALUATION.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Director 
of the Office of EMS and Trauma, in consultation 
with the Administrator of the Centers for Medicare 
& Medicaid Services (in this section referred to as 
the ‘‘Director’’), and taking into consideration the 
recommendations of NEMSAC and FICEMS, shall 
complete an evaluation of— 
(A) the provision of and reimbursement for 
alternative delivery models for medical care 
through field EMS; and 
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(B) the integration of field EMS patients 
with other medical providers and facilities as 
medically appropriate. 
(2) SPECIFIC
ISSUES.—The evaluation under 
paragraph (1) shall consider each of the following: 
(A) Alternative dispositions of patients, in-
cluding— 
(i) transporting patients by ambulance 
to destinations other than a hospital such 
as the office of the patient’s physician, an 
urgent care center, or the facilities of an-
other health care provider; 
(ii) when medically necessary, the 
evaluation, treatment, or referral of pa-
tients to other medically appropriate health 
care providers; and 
(iii) the funding of the provision of 
medical care regardless of the decision to 
transport such as reimbursement models 
based on readiness rather than transport 
and shared savings. 
(B) Issues related to medical liability and 
the requirements of section 1867 of the Social 
Security Act (42 U.S.C. 1395dd; commonly re-
ferred to as ‘‘EMTALA’’) associated with 
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transport to destinations other than a hospital 
emergency department. 
(C) Necessary protections to ensure that 
patients receive timely and appropriate care in 
the appropriate setting. 
(D) Whether there are any barriers to pro-
viding alternate dispositions to patients who are 
not in need of care in hospital emergency de-
partments. 
(E) Other issues determined by the Direc-
tor, including, when possible, issues rec-
ommended by FICEMS or NEMSAC for eval-
uation under this subsection. 
(b) DEMONSTRATION PROJECTS.— 
(1) IN GENERAL.—Beginning not later than 1 
year after the date of the enactment of this Act, the 
Director shall conduct or support at least 10 dem-
onstration projects to— 
(A) evaluate the implementation and reim-
bursement of alternative dispositions of field 
EMS patients, including— 
(i) transporting patients by ambulance 
to alternate destinations when medically 
appropriate and in the patients’ best inter-
ests; and 
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(ii) when medically necessary, evalu-
ating, treating, or referring patients to 
other medically appropriate providers; 
(B) evaluate the implementation of reim-
bursement models based on readiness rather 
than transport or shared savings; and 
(C) determine whether such alternative dis-
positions and reimbursement models— 
(i) improve the safety, effectiveness, 
timeliness, and efficiency of EMS; and 
(ii) reduce overall utilization and ex-
penditures under the Medicare program 
under title XVIII of the Social Security 
Act. 
(2) EVIDENCE-BASED PROTOCOLS.—The Direc-
tor shall ensure that at least one demonstration 
project under paragraph (1) evaluates evidence- 
based protocols that give guidance on selection of 
the destination to which patients are transported. 
(3) DURATION.—The period of a demonstration 
project under paragraph (1) shall not exceed 36 
months. 
(4) RESEARCH.—If the Director determines 
that further research is necessary prior to or in con-
junction with the demonstration projects under this 
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subsection in order to evaluation the implementation 
of alternative dispositions of field EMS patients, the 
Director shall conduct or support such research. 
(5) AUTHORIZATION OF APPROPRIATIONS.—Of 
the amount made available to carry out section 
1115A of the Social Security Act (42 U.S.C. 1315a) 
for a fiscal year, there are authorized to be appro-
priated such sums as may be necessary to carry out 
this subsection. 
(c) REPORT TO CONGRESS.—Not later than 1 year 
after the completion of all demonstration projects under 
subsection (b), the Director shall submit to the Congress 
a report on the results of activities under this section, in-
cluding recommendations on the efficacy of alternative dis-
positions of field EMS patients. 
SEC. 10. ENHANCING RESEARCH IN FIELD EMS. 
(a) MODELS TO BE TESTED BY CENTER FOR MEDI-
CARE
AND
MEDICAID
INNOVATION.—Section 
1115A(b)(2)(B) of title XI of the Social Security Act (42 
U.S.C. 1315a(b)(2)(B)) is amended by adding at the end 
the following: 
‘‘(xxi) Enhancing health outcomes for 
patients receiving field emergency medical 
services and improving timely and efficient 
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delivery of high-quality field emergency 
medical services, such as through— 
‘‘(I) regionalization of emergency 
care; 
‘‘(II) medical transport to alter-
nate destinations; or 
‘‘(III) when medically necessary, 
the evaluation, treatment, or referral 
of patients to other medically appro-
priate health providers.’’. 
(b) EMERGENCY
MEDICAL
RESEARCH.—Section 
498D of the Public Health Service Act (42 U.S.C. 289g– 
4) is amended— 
(1) by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively; and 
(2) by inserting after subsection (b) the fol-
lowing: 
‘‘(c) FIELD
EMS EMERGENCY
MEDICAL
RE-
SEARCH.—The Secretary shall conduct research and eval-
uation relating to field EMS through the Agency for 
Healthcare Research and Quality and the Center for Medi-
care and Medicaid Innovation.’’. 
(c) FIELD EMS PRACTICE CENTER.—Subpart II of 
part D of title IX of the Public Health Service Act (42 
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U.S.C. 299b–33 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 938. FIELD EMS PRACTICE CENTER. 
‘‘(a) ESTABLISHMENT.—For the purpose described 
in subsection (b), the Director shall establish within the 
Office of Research and Evaluation a Field EMS Evidence- 
Based Practice Center. 
‘‘(b) PURPOSE.—The purpose of the Center is to con-
duct or support research to promote the highest quality 
of emergency medical care in field EMS and the most ef-
fective delivery system for the provision of such care. Re-
search conducted or supported pursuant to the preceding 
sentence shall include— 
‘‘(1) comparative safety and effectiveness re-
search; 
‘‘(2) other appropriate clinical or systems re-
search; and 
‘‘(3) research addressing— 
‘‘(A) critical care transport; 
‘‘(B) off-shore operations; 
‘‘(C) tactical emergency medical services; 
‘‘(D) air medical services; and 
‘‘(E) the application of lessons learned in 
military field medicine in the delivery of emer-
gency medical care in field EMS. 
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‘‘(c) DEFINITION.—In this section: 
‘‘(1) The term ‘Center’ means the Field EMS 
Evidence-Based Practice Center established under 
subsection (a). 
‘‘(2) The term ‘field EMS’ has the meaning 
given to such term in section 3 of the Field EMS 
Quality, Innovation, and Cost Effectiveness Improve-
ments Act of 2013.’’. 
(d) LIMITATIONS
ON
CERTAIN
USES
OF
RE-
SEARCH.—Section 1182 of the Social Security Act (42 
U.S.C. 1320e–1) is amended by striking ‘‘section 1181’’ 
each place it appears and inserting ‘‘section 1181 of this 
Act or section 498D(c) or 938 of the Public Health Serv-
ice Act’’. 
(e) REGULATORY BARRIERS.—For the purposes of 
research conducted pursuant to this section or any other 
research funded by the Department of Health and Human 
Services related to emergency medical services in the field 
in which informed consent is required but may not be at-
tainable, the Secretary of Health and Human Services 
shall— 
(1) evaluate and consider the patient and re-
search issues involved; and 
(2) address regulatory barriers to such research 
related to the need for informed consent in a man-
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ner that ensures adequate patient safety and notifi-
cation, and submit recommendations to Congress for 
any changes to Federal statutes necessary to ad-
dress such barriers. 
SEC. 11. EMERGENCY MEDICAL SERVICES TRUST FUND. 
(a) DESIGNATION OF INCOME TAX OVERPAYMENTS 
AND
ADDITIONAL
CONTRIBUTIONS
FOR
EMERGENCY 
MEDICAL SERVICES.—Subchapter A of chapter 61 of the 
Internal Revenue Code of 1986 (relating to returns and 
records) is amended by adding at the end the following 
new part: 
‘‘PART IX—DESIGNATION OF INCOME TAX OVER-
PAYMENTS 
AND 
ADDITIONAL 
CONTRIBU-
TIONS FOR EMERGENCY MEDICAL SERVICES 
‘‘SEC. 6097. DESIGNATION BY INDIVIDUALS. 
‘‘(a) IN GENERAL.—Every individual (other than a 
nonresident alien)— 
‘‘(1) may designate that a specified portion of 
any overpayment of tax for a taxable year, and 
‘‘(2) may designate that an amount in addition 
to any payment of tax for such taxable year and any 
designation under paragraph (1), 
shall be used to fund the Emergency Medical Services 
Trust Fund. Designations under the preceding sentence 
shall be in an amount not less than $1 and the Secretary 
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shall provide for elections in amounts of $1, $5, $10, or 
such other amount as the taxpayer designates. 
‘‘(b) ADJUSTED INCOME TAX LIABILITY.—For pur-
poses of this section, the term ‘adjusted income tax liabil-
ity’ means income tax liability (as defined in section 
6096(b)) reduced by any amount designated under section 
6096 (relating to designation of income tax payments to 
Presidential Election Campaign Fund). 
‘‘(c) OVERPAYMENTS TREATED AS REFUNDED.—For 
purposes of this title, any portion of an overpayment of 
tax designated under subsection (a) shall be treated as— 
‘‘(1) being refunded to the taxpayer as of the 
last date prescribed for filing the return of tax im-
posed by chapter 1 (determined without regard to 
extensions) or, if later, the date the return is filed, 
and 
‘‘(2) a contribution made by such taxpayer on 
such date to the United States. 
‘‘(d) MANNER AND TIME OF DESIGNATION.—A des-
ignation under subsection (a) may be made with respect 
to any taxable year— 
‘‘(1) at the time of filing the return of the tax 
imposed by chapter 1 for such taxable year, or 
‘‘(2) at any other time (after the time of filing 
the return of the tax imposed by chapter 1 for such 
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