HBA-NRS H.B. 2446 77(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 2446 By: Glaze Public Health 8/28/2001 Enrolled BACKGROUND AND PURPOSE Individuals with allergies and asthma can experience a severe allergic reaction that results in anaphylactic shock, which is life-threatening. Nationally, an estimated 50 people die each year as a result of insect sting reactions, according to the American College of Allergy, Asthma, and Immunology. As well, the Journal of Allergy and Clinical Immunology documented 32 cases of fatal food allergy-induced anaphylaxis between 1994 and 1999. The preferred treatment for severe allergic reactions is the subcutaneous administration of epinephrine, also known as adrenalin. Texas has four levels of emergency medical technicians (EMTs). However, prior to the 77th Legislature, only EMT paramedics were permitted to carry and administer epinephrine, while basic and intermediate EMTs could only assist an individual in administering the individual's own auto-injector of epinephrine. Fatal outcomes are most often associated with either not using epinephrine or a delay in its use. Equipping all levels of EMTs with the knowledge and authority to carry and administer epinephrine could save lives. House Bill 2446 provides for the training and use of epinephrine auto-injector devices by all EMTs and first response providers in Texas. In addition, the House Committee on Public Health (committee) examined the requirements imposed on emergency medical service (EMS) providers in rural areas and determined whether individual requirements encourage or hinder the provision of services. In its interim report to the 77th Texas Legislature. The committee outlined several policy options including allowing an advisory council to advise the Texas Board of Health (board) on emergency medical services, allowing counties to reimburse EMS providers under the Indigent Health Care and Treatment Act at Medicaid rates, and considering the standardization and simplification of EMS terminology and classification of providers. The committee also met with the Texas Department of Health (TDH), which recommended establishing a peer assistance program and providing confidentiality for the regional advisory council's quality improvement and data process. House Bill 2446 addresses the recommendations outlined in the interim report along with recommendations by TDH RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Health in SECTION 3 (Section 773.013, Health and Safety Code) and SECTION 7 (Section 773.115, Health and Safety Code) and to the Texas Department of Health in SECTION 4 (Section 773.014, Health and Safety Code) and SECTION 11. ANALYSIS House Bill 2446 amends the Health and Safety Code to require the Texas Department of Health (TDH), with the assistance of the advisory council appointed to advise the Texas Board of Health (board) on the Emergency Medical Services Act to establish a pilot program to test the efficacy of using emergency medical dispatchers located in a regional emergency medical dispatch resource center (center) to provide lifesaving and other emergency medical instructions to persons who need guidance while awaiting the arrival of emergency medical personnel. The bill requires the Commission on State Emergency Communications (commission) to provide technical assistance to TDH to facilitate the implementation of the pilot program. The bill requires TDH, with the cooperation of the advisory council to design criteria and protocols and provide oversight as needed to conduct the pilot program, to collect the necessary data to evaluate the outcome of the pilot program, and to report its findings to the legislature (Sec. 771.101). The bill requires TDH to determine which public safety answering points are interested in participating in the pilot program and to establish criteria for selecting such answering points (Sec. 771.102). The bill requires TDH, with the assistance of the advisory council, to select one public safety answering point to serve as the center. The bill provides that the public safety answering point selected as the resource center for the pilot program must conform to certain requirements (Sec. 771.103). The bill requires TDH and the advisory council to define criteria that establish the need for emergency medical dispatch intervention to be used by participating public safety answering points to determine which calls are to be transferred to the center for emergency medical dispatch intervention (Sec. 771.104). The bill authorizes money in the 9-1-1 services fee fund to be appropriated to TDH to fund the pilot program (Sec. 771.105). The bill provides that TDH is also authorized to seek grant funding for the pilot program. The bill requires TDH to report its findings to the presiding officer of each house of the legislature no later than December 1, 2002 (Sec. 771.106). The bill provides that the operations of the center are considered to be the provision of 9-1-1 services for purposes of related liability provisions (Sec. 771.107). The bill provides that provisions relating to the center expire September 1, 2003 (Sec. 771.108). The bill requires the governor to ensure that approximately one-half of the members of the advisory council that advises the board regarding matters related to the responsibilities of the board, the commissioner, and TDH under the Emergency Medical Services Act are residents of rural areas of the state. The bill requires the advisory council to assess the need for emergency medical services in rural areas and to develop a strategic plan for refining the educational requirements for certification and maintaining certification as emergency medical services personnel and for developing emergency medical services and trauma care systems (Sec. 773.012). The bill authorizes TDH to establish, approve, and fund a peer assistance program in accordance with minimum criteria established by the Texas Commission on Alcohol and Drug Abuse and in accordance with board rules (Sec. 773.013). H.B.2446 authorizes an emergency medical services (EMS) provider and a first responder organization to acquire and possess epinephrine auto-injector devices. The bill authorizes EMS personnel certified as or at a higher level than emergency medical technicians (EMS personnel) to carry and administer epinephrine auto-injector devices. The use of epinephrine auto-injector devices under these provisions is authorized only in accordance with Texas Department of Health (TDH) rules and a delegated practice agreement that provides for medical supervision by a specified licensed physician. The bill requires EMS personnel who administer epinephrine auto-injector devices to others to immediately report the use to the supervising physician. H.B. 2446 requires TDH to adopt rules to administer these provisions, including a rule that EMS personnel are authorized to administer an epinephrine auto-injector device to another only if the person has successfully completed a training course approved by TDH in the use of the device. The bill provides that the administration of an epinephrine auto-injector device to another is considered to be the administration of emergency care for legal purposes relating to liability for the provision of emergency care and does not constitute the unlawful practice of any health care profession. The provisions of this bill do not impose a standard of care not otherwise required by law. The bill authorizes a governmental entity or nongovernmental organization that sponsors or wishes to sponsor an emergency medical services provider or first responder organization in a rural or underserved area to request TDH's bureau of emergency management (bureau) to provide or facilitate the provision of initial training for emergency care attendants, if the training is not available locally. The bill requires the bureau to ensure that the training is provided, and requires the bureau to provide services free of charge to students who agree to perform emergency care attendant services for at least one year with the local emergency medical services provider or first responder organizations. The bill requires the bureau to consult with experienced emergency medical service personnel to facilitate all levels of emergency medical services training (Sec. 773.025). The bill provides that the proceedings and records of organized committees of emergency medical services and trauma care systems relating to the review, evaluation, or improvement of such systems are confidential and not subject to disclosure by court subpoena or otherwise (Sec. 773.095). The bill requires a trauma care facility to be designated by the bureau according to the level of trauma care and services provided in accordance with the American College of Surgeons guidelines for level I and level II trauma facilities and rules adopted by the board for level III and IV trauma facilities. The bill removes the level V trauma designation (Sec. 773.115). H.B. 2446 amends the Government Code to include survivors of an emergency services volunteer, an emergency care attendant, and a licensed paramedic in the list of those eligible for financial assistance through the Employees Retirement System of Texas (Sec. 615.003). The bill amends the Health and Safety Code to authorize a county, in accordance with TDH rules, to receive payments through Medicaid for emergency medical services provided under the Indigent Health Care and Treatment Act (Sec. 61.0285). The bill modifies the composition of the advisory committee for the executive committee of the Center for Rural Health Initiatives to include an individual who provides emergency medical services in a rural area who is certified or licensed as an emergency care attendant or at a higher level of training (Sec. 106.043). EFFECTIVE DATE September 1, 2001. Provisions relating to the administration of epinephrine take effect January 1, 2002, except that those same provisions take effect September 1, 2001, for the limited purpose of allowing the Texas Department of Health to adopt rules under that law that may take effect before January 1, 2002.