Bill Summary – FastDemocracy

OHIO LEGISLATIVE SERVICE COMMISSION
                                              Office of Research                             Legislative Budget
www.lsc.ohio.gov                                and Drafting                                       Office
                               H.B. 138                          Final Analysis
                      134th   General Assembly
                                                                    Click here for H.B. 138’s Fiscal Note
    Primary Sponsor: Rep. Baldridge
    Effective date: July 6, 2022
    Effective Date:
    Jason Hoskins, Attorney                                                                        UPDATED VERSION
                                                         SUMMARY
                       Eliminates the enumeration of specific services that may be provided by emergency
                          medical service (EMS) personnel.
                       Requires the State Board of Emergency Medical, Fire, and Transportation Services to
                          establish the scope of practice for EMS personnel through rulemaking.
                       Permits EMS personnel to comply with a do-not-resuscitate order issued by a physician
                          assistant or advanced practice registered nurse.
                       Requires the medical director or cooperating physician advisory board of each EMS
                          organization to establish protocols for EMS personnel to follow when providing services
                          at all times.
                       Establishes conditions on the Board’s adoption of rules regarding qualifications for a
                          physician to serve as an EMS organization’s medical director or a member of its
                          cooperating physician advisory board that generally require all physicians to meet the
                          same qualifications.
                       Expressly requires an EMS organization to appoint a medical director or cooperating
                          physician advisory board.
                       Establishes ambulance staffing requirements when a patient is being transported in
                          nonemergency situations.
                       Eliminates a requirement that an individual seeking to practice as a first responder be a
                          volunteer for a nonprofit EMS organization or nonprofit fire department.
     This version updates the effective date.
                                                                                                            April 12, 2022
Office of Research and Drafting                      LSC                       Legislative Budget Office
       Permanently reauthorizes EMS personnel who have received proper training to
          (1) administer COVID-19 tests and (2) collect and label test specimens.
                                  DETAILED ANALYSIS
Services by EMS personnel
        The act modifies the laws governing the services that may be provided by first responders,
emergency medical technicians-basic, emergency medical technicians-intermediate, and
paramedics (EMS personnel). Prior law enumerated the services that each type of EMS personnel
could provide. The act eliminates this enumeration and, instead, requires the State Board of
Emergency Medical, Fire, and Transportation Services to establish the scope of practice for each
type of EMS personnel through the rulemaking process.1
         The act makes two additional changes related to the general practice of EMS personnel.
First, it permits EMS personnel to comply with a do-not-resuscitate (DNR) order issued by a
physician assistant or advanced practice registered nurse.2 Prior law permitted EMS personnel to
comply with a DNR order only when issued by a physician. Second, the act requires the medical
director or cooperating physician advisory board of each EMS organization to establish protocols
to be followed by EMS personnel when providing all services. Prior law required that these
protocols be established only for circumstances when communications failed or were prevented
and a patient’s life was in immediate danger.3
Qualifications of EMS organization medical directors
       Continuing law authorizes the Board to adopt rules regarding the minimum qualifications
of persons who provide medical direction to EMS personnel.4 The rules previously adopted by
the Board required a physician to meet several qualifications to serve as a medical director of an
EMS organization. Under those rules, a physician was required present to the Board evidence
that the physician either (1) held national board certification in emergency medicine, (2) had
completed an emergency medicine residency program, (3) held national board certification in a
designated medical specialty and had completed an emergency medical services or emergency
medicine fellowship, or (4) held a national subspecialty board certification in emergency medical
services. A physician who could not provide evidence of any of those qualifications could still
become a medical director upon the completion of an approved EMS medical director course.5
       The act establishes several conditions regarding the Board’s authority to adopt rules
about the qualifications to serve as a medical director of an EMS organization or as a member of
1   R.C. 4765.11, 4765.35, 4765.37, 4765.38, and 4765.39.
2   R.C. 4765.35(B)(2), 4765.37(B)(2), 4765.38(B)(2), and 4765.39(B)(2).
3   R.C. 4765.41.
4   R.C. 4765.11(A)(22).
5   Ohio Administrative Code 4765-3-05(A)(6), (B), and (C).
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                                                                                         Final Analysis
Office of Research and Drafting               LSC                           Legislative Budget Office
a physician advisory board. These conditions generally require that all physicians meet the same
qualifications regarding medical experience and the completion of a medical director course.6
        Concerning medical experience, the act prohibits the Board from limiting eligibility to
serve as a medical director to only physicians who have completed a residency or fellowship
program in emergency medicine or a related area or those who are certified or eligible to be
certified in a specialty or subspecialty of emergency medicine or a related area. With respect to
completing a medical director course, the Board must permit a physician who has completed a
residency or fellowship program in emergency medicine or a related field to use completion of
that program as evidence of having completed a medical director course.7
        The act specifies that the above conditions apply only to physicians who are appointed to
serve in either capacity on or after July 6, 2022, the act’s effective date.8
        Additionally, the act expressly requires each EMS organization to appoint a medical
director or a cooperating physician advisory board.9 Continuing law makes references to the
existence of a medical director or physician advisory board for an EMS organization, including
notification of their identities to the Board, but had not previously specifically addressed the
appointment of these individuals.
Ambulance staffing for nonemergency patient transports
       The act establishes requirements regarding the staffing levels of an ambulance when
transporting a patient in nonemergency situations. The act defines “nonemergency transport” as
the transportation of a convalescent, nonambulatory individual who requires routine
transportation to or from a medical appointment or service and does not require medical
monitoring, aid, care, or treatment during the transport to the destination facility.10
        During nonemergency transport, an ambulance is required to be staffed by at least two
individuals. One individual (the driver) must meet the requirements to drive an ambulance in a
nonemergency situation, as established in rules adopted by the Board. The act specifies that the
driver does not necessarily need to be an EMT or paramedic. The second individual must be an
EMT (at the basic or intermediate level) or a paramedic. The act requires the Board to adopt any
necessary rules to implement these requirements.11
6   R.C. 4765.42(B).
7   R.C. 4765.42(B)(1) and (2).
8   Section 3.
9   R.C. 4765.42(A).
10   R.C. 4765.431(A)(3).
11   R.C. 4765.431.
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                                                                                      Final Analysis
Office of Research and Drafting                     LSC                        Legislative Budget Office
Volunteer status of first responders
         The act eliminates a requirement that an individual seeking a certificate to practice as a
first responder meet either of the following conditions: (1) be a volunteer for a nonprofit EMS
organization or a nonprofit fire department or (2) receive a waiver of requirement to be such a
volunteer.12
EMS personnel and COVID-19 testing services
        The act permanently revives the authority of EMS personnel who have received proper
training to (1) administer COVID-19 tests and (2) collect and label test specimens. This authority
expired May 1, 2021 under S.B. 310 of the 133rd General Assembly.13
                                             HISTORY
                               Action                                        Date
 Introduced                                                     02-18-21
 Reported, H. Transportation and Public Safety                  06-09-21
 Passed House (93-0)                                            06-16-21
 Reported, S. Health                                            03-02-22
 Passed Senate (30-0)                                           03-16-22
 House concurred in Senate amendments (95-0)                    03-23-22
22-ANHB0138EN-Updated-134/ts
12   R.C. 4765.30.
13   R.C. 4765.53; see Section 12 of SB 310 of the 133rd General Assembly.
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                                                                                         Final Analysis
Statutes affected: 
As Introduced: 4765.01, 4765.11, 4765.30, 4765.35, 4765.37, 4765.38, 4765.39, 4765.41, 4766.01
As Reported By House Committee: 4765.01, 4765.11, 4765.30, 4765.35, 4765.37, 4765.38, 4765.39, 4765.41, 4766.01
As Passed By House: 4765.01, 4765.11, 4765.30, 4765.35, 4765.37, 4765.38, 4765.39, 4765.41, 4766.01
As Reported By Senate Committee: 4765.01, 4765.11, 4765.30, 4765.35, 4765.37, 4765.38, 4765.39, 4765.41, 4765.42, 4766.01
As Passed By Senate: 4765.01, 4765.11, 4765.30, 4765.35, 4765.37, 4765.38, 4765.39, 4765.41, 4765.42, 4766.01
As Enrolled: 4765.01, 4765.11, 4765.30, 4765.35, 4765.37, 4765.38, 4765.39, 4765.41, 4765.42, 4766.01