I 
114TH CONGRESS 
1ST SESSION H. R. 2366 
To provide for improvement of field emergency medical services, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2015 
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 Modernization and Innovation Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Aligning ambulance reimbursement with value-based and high-quality 
field EMS. 
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Sec. 4. Field emergency medical services. 
Sec. 5. Integration of field EMS into the National Health Information Infra-
structure. 
Sec. 6. Clarification of leadership responsibility for routine emergency medical 
care. 
Sec. 7. Enhancing evidence-based care in field EMS. 
Sec. 8. Emergency medical services trust fund. 
Sec. 9. GAO study to identify impediments to quality improvement in field 
EMS. 
Sec. 10. Funding. 
Sec. 11. Statutory construction. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Patients with emergency medical conditions 
depend upon field emergency medical services (re-
ferred to in this section as ‘‘EMS’’) for essential life- 
saving or unscheduled medical care. All people in the 
United States should have access to and receive 
high-quality emergency medical care as part of a co-
ordinated EMS system. 
(2) The Institute of Medicine, in its 2006 re-
port ‘‘Emergency Medical Services at the Cross-
roads’’, outlined its vision of a 21st century emer-
gency care system that is integrated, regionalized, 
accountable, and prepared for both routine emer-
gency medical care and public health emergencies. 
Such a modernized system would be characterized by 
a highly trained and capable field EMS practitioner 
workforce that delivers high-quality, evidence-based, 
innovative, value-based, and patient-centered emer-
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gency care in the field and across the emergency 
care continuum. 
(3) In such 2006 report, the Institute of Medi-
cine also outlined systemic problems plaguing field 
EMS that impede achievement of a 21st century 
emergency care system, including insufficient coordi-
nation, disparate response times, uncertain quality 
of care, lack of readiness for disasters, divided pro-
fessional identity of field EMS practitioners, and a 
limited evidence base for the emergency medical care 
provided in the field. 
(4) To modernize the field EMS system, the In-
stitute of Medicine recommended that advancements 
be made in several priority areas, including readi-
ness, innovation, preparedness, education and work-
force development, safety, financing, quality, stand-
ards, and research. The Institutes of Medicine also 
recommended recognition of a lead programmatic 
Federal agency for emergency medical services with-
in the Department of Health and Human Services to 
provide a more streamlined, cost-efficient, and com-
prehensive approach for field EMS, and a focal point 
for practitioners and agencies to interface with the 
Federal Government. 
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(5) Under an amendment made by the Pan-
demic and All-Hazards Preparedness Act (Public 
Law 109–417), the Secretary of Health and Human 
Services is already established as the lead of all Fed-
eral public health and medical response for public 
health emergencies and incidents. Preparedness and 
capability to deliver routine emergency medical care 
is a prerequisite for preparedness and capability to 
respond to public health emergencies and incidents. 
(6) In 2007, the Homeland Security Presi-
dential Directive HSPD–21 called for the establish-
ment within the Department of Health and Human 
Services of an Office for Emergency Medical Care to 
lead an enterprise to promote and fund research in 
emergency medicine and trauma care; promote re-
gional partnerships and more effective emergency 
medical systems in order to enhance appropriate 
triage, distribution, and care of routine community 
patients; and promote local, regional, and State 
emergency medical systems’ preparedness for and 
response to public health events. Under the Direc-
tive, the Office would address the full spectrum of 
issues that have an impact on care in hospital emer-
gency departments, including the entire continuum 
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of patient care from prehospital to disposition from 
emergency or trauma care. 
(7) Properly functioning EMS systems encom-
pass fully mobile resources that are able to address 
patient needs 24 hours per day, 7 days per week, 
365 days a year. Field EMS serves as an essential 
health care safety net by providing emergency, ur-
gent, and mobile medical care throughout the health 
care continuum, including medical and trauma care 
provided in the field, hospital, rehabilitation, and 
other settings. Ensuring high-quality and cost-effec-
tive emergency medical services systems requires 
readiness, preparedness, medical oversight, and inno-
vation throughout the continuum of emergency med-
ical care through Federal, State, and local multi-ju-
risdictional collaboration and sufficient resources for 
EMS agencies and practitioners. 
(8) Field EMS is the delivery of health care, 
not simply a transportation benefit having evolved 
from a patient transport model to a health care serv-
ice delivery model that provides a variety of targeted 
medical services to meet the specific needs of their 
communities. This includes the development of com-
munity paramedicine as a health care service pro-
vided by field EMS agencies and mobile integrated 
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