A4576

An Act concerning basic life support services, supplementing Title 26 of the Revised Statutes, and amending P.L.2021, c.477.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. (New section) a. As used in this section:

“Basic life support” means a basic level of pre-hospital care which includes patient stabilization, airway clearance, cardiopulmonary resuscitation, hemorrhage control, initial wound care and fracture stabilization and other techniques and procedures authorized by the commissioner.

"Commissioner" means the Commissioner of Health.

“In service” means the presence of a basic life support ambulance at a sending or receiving health care facility; the picking up, transporting or discharging of any patient; or any instance where the basic life support ambulance is ready to accept patients and perform basic life support services.

"Pre-hospital care" means those emergency medical services rendered to emergency patients before and during transportation to emergency treatment facilities, and upon arrival within those facilities.

“Volunteer emergency medical technician” means an emergency medical technician who staffs a basic life support vehicle and provides basic life support services without compensation, for whose services neither the emergency medical technician nor the first aid, rescue and ambulance squad the emergency medical technician is a member of receives payment.

b. Notwithstanding the provisions of P.L.2021, c.477 or any other law to the contrary, a basic life support services vehicle, when in service, may be staffed by one volunteer emergency medical technician and one first responder, each of whom shall be authorized to render care within that individual’s scope of practice. The volunteer emergency medical technician shall be present in the patient compartment of the vehicle at all times when a patient is present in the vehicle.

c. Each individual staffing a basic life support vehicle pursuant to subsection b. of this section shall be at least 18 years of age. In addition, a first responder staffing a basic life support vehicle shall:

(1) be certified to administer cardio-pulmonary resuscitation;

(2) be able to operate a basic life support vehicle; and

(3) possess a certification from the National Safety Council, National Registry of Emergency Medical Technicians, American Red Cross, Emergency Care and Safety Institute, the American Health and Safety Institute, or an equivalent certification of having completed a training program that has been approved by the basic life support agency medical director and that includes, at a minimum, safe vehicle operations, patient lifting and moving, safe use of patient restraints, basic first aid, and documentation.

d. Nothing in this section shall be construed to:

(1) revise the requirements for certification, or to practice, as an emergency medical technician in New Jersey;

(2) revise the scope of practice authorized for emergency medical technicians in New Jersey; or

(3) revise the standards or requirements for equipment for basic life support vehicles.

2. Section 1 of P.L.2021, c.477 is amended to read as follows:

1. a. As used in this section:

“ACLS certification” means valid certification in Advanced Cardiac Life Support as issued by the American Heart Association.

“Advanced life support” means an advanced level of pre-hospital, inter-hospital, and emergency service care which includes basic life support functions, cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of anti-arrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care and other techniques and procedures authorized in writing by the Commissioner of Health.

"Basic life support" means a basic level of pre-hospital care which includes patient stabilization, airway clearance, cardiopulmonary resuscitation, hemorrhage control, initial wound care and fracture stabilization, and other techniques and procedures authorized by the Commissioner of Health.

“Emergency medical technician-paramedic” means a person trained in advanced life support services and certified by the Commissioner of Health to render advanced life support services as part of a mobile intensive care unit.

"First responder" means a police officer, firefighter, or other person who has been trained to provide emergency medical first response services in a program recognized by the Commissioner of Health.

“ITLS certification” means valid certification in International Trauma Life Support as issued by the American College of Emergency Physicians.

“Mobile intensive care nurse” means a registered nurse who: has completed at least one year of full-time nursing care performing advanced clinical skills in the critical care unit or emergency department of an acute care hospital; possesses Emergency Medical Technician-Basic, cardiopulmonary resuscitation, and ACLS certifications; possesses PALS or Pediatric Education for Prehospital Professionals-Advanced certification or has successfully completed the Emergency Nurse Pediatric Course to the standards of the Emergency Nurses Association; possesses either PHTLS or ITLS certification; has successfully completed at least a mobile intensive care unit field internship consisting of at least 100 hours, has successfully intubated at least five patients and has demonstrated proficiency in pre-hospital advanced life support treatment to the satisfaction of the nurse’s mobile intensive care program's medical director; is physically capable of performing the duties of a mobile intensive care nurse; and is endorsed by the medical director of a mobile intensive care program.

“Mobile intensive care unit” means a specialized emergency medical service vehicle operated for the provision of advanced life support services under the direction of an authorized hospital.

“PALS certification” means valid certification in Pediatric Advanced Life Support as issued by the American Heart Association.

“PHTLS certification” means valid certification in Pre-Hospital Trauma Life Support as issued by the National Association of EMTs.

“Specialty care transport nurse” means a registered nurse who has: completed at least one year of full time nursing care performing advanced clinical skills in an acute care hospital's critical care unit or emergency department and possesses valid certification as either a critical care registered nurse or a certified emergency nurse; holds certifications in CPR and ACLS; holds certification in PALS or has successfully completed the Emergency Nurse Pediatric Course to the standards of the Emergency Nurses Association; has additional training in endotrachael intubation and has been deemed competent by the medical director; and has documented completion of competencies for advanced life support equipment, including, but not limited to, cardiac monitor/defibrillator, external pacemaker, IV pump, ventilator, intra-aortic balloon pump, specialized respirators, and incubators.

"Specialty care transport unit" means a specialized transport medical service vehicle that is validly licensed by the department and operated in accordance with rules and regulations promulgated by the department.

b. (1) Until January 1, 2023, a basic life support services vehicle other than a basic life support services vehicle described in subsection d. of this section, when in service, shall be staffed by a minimum of two emergency medical technicians or by a minimum of one emergency medical technician and one first responder. Any individual staffing a basic life support vehicle as provided in this paragraph shall be authorized to render care within that individual’s scope of practice. In the case of a vehicle staffed by one emergency medical technician and one first responder, the emergency medical technician shall be present in the patient compartment of the vehicle at all times when a patient is present in the vehicle.

(2) Until January 1, 2023, a mobile intensive care unit, when in service, shall be staffed by a minimum of two persons, which two persons may be two emergency medical technician-paramedics, two mobile intensive care nurses, one emergency medical technician-paramedic and one mobile intensive care nurse, or one emergency medical technician and one emergency medical technician-paramedic or mobile intensive care nurse. Any individual staffing a mobile intensive care unit as provided in this paragraph shall be authorized to render care within that individual’s scope of practice. In the case of a mobile intensive care unit staffed by one emergency medical technician and one emergency medical technician-paramedic or mobile intensive care nurse, the emergency medical technician-paramedic or mobile intensive care nurse shall provide primary patient care.

(3) Until January 1, 2023, a specialty care transport unit, when in service, shall be staffed by a minimum of one specialty care transport nurse and one emergency medical technician. Any individual staffing a specialty care transport unit as provided in this paragraph shall be authorized to render care within that individual’s scope of practice. The specialty care transport nurse shall provide primary patient care.

c. Each individual staffing a basic life support vehicle, a mobile intensive care unit, or a specialty care transport unit pursuant to subsection b. of this section shall be at least 18 years of age. In addition, a first responder staffing a basic life support vehicle pursuant to paragraph (1) of subsection b. of this section shall:

(1) be certified to administer cardio-pulmonary resuscitation;

(2) be able to operate a basic life support vehicle; and

(3) have completed a training program that has been approved by the basic life support agency medical director and that includes, at a minimum: safe vehicle operations; patient lifting and moving; safe use of patient restraints; basic first aid; and documentation.

d. (1) The provisions of subsection b. of this section shall not apply to a basic life support vehicle dispatched in response to a 9-1-1 emergency call, which vehicles, when in service, shall be staffed by a minimum of two emergency medical technicians.

(2) The provisions of paragraph (1) of subsection b. of this section and paragraph (1) of this subsection shall not apply to any basic life support services vehicle staffed by one volunteer emergency medical technician and one first responder pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill).

e. Nothing in this section shall be construed to:

(1) revise the requirements for certification, or to practice, as an emergency medical technician, an emergency medical technician-paramedic, a mobile intensive care nurse, or a specialty care transport nurse in New Jersey;

(2) revise the scope of practice authorized for emergency medical technicians, emergency medical technician-paramedics, mobile intensive care nurses, or specialty care transport nurses in New Jersey; or

(3) revise the standards or requirements for equipment for basic life support vehicles, mobile intensive care units, or specialty care transport units.

(cf: P.L.2021, c.477, s.1)

3. This act shall take effect immediately.

STATEMENT

This bill provides that, when in service, a basic life support services (BLS) vehicle may be staffed by one volunteer emergency medical technician (EMT) and one first responder. The bill defines a volunteer EMT to mean an EMT who staffs a BLS vehicle and provides basic life support services without compensation, and for whose services neither the EMT nor the BLS squad the EMT is a member of receives payment.

Any individual staffing a BLS vehicle under the bill will be authorized to render care within that individual’s scope of practice. The volunteer EMT will be required to be present in the patient compartment of the vehicle at all times when a patient is present in the vehicle.

The bill requires each individual staffing a BLS vehicle to be at least 18 years of age. In addition, a first responder staffing a BLS vehicle will be required to: 1) be certified to administer cardio-pulmonary resuscitation; 2) be able to operate a BLS vehicle; and 3) possess a certification of having completed a training program that has been approved by the BLS agency medical director that includes, at a minimum, safe vehicle operations, patient lifting and moving, safe use of patient restraints, basic first aid, and documentation.

Nothing in the bill is to be construed to revise the requirements for certification, or to practice, as an EMT in New Jersey, the scope of practice authorized for EMTs in New Jersey, or the standards or requirements for equipment for BLS vehicles.

The bill revises P.L.2021, c.477, which, through January 1, 2023, allows BLS vehicles to be staffed by one EMT and one first responder, but only on non-9-1-1 calls. The bill amends that law to provide an express exemption from the requirements of that enactment for BLS vehicles staffed by one volunteer EMT and one first responder.

Some BLS squads use a hybrid of volunteer and non-volunteer EMTs. Those squads do not always have two EMTs available to staff a given shift, meaning that the squads would be unable to provide the full level of services they currently provide.