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Title 44 - Health
EMERGENCY MEDICAL SERVICES
EMERGENCY MEDICAL SERVICES
This chapter may be cited as "The Emergency Medical Services Act of South Carolina."
As used in this chapter, and unless otherwise specified, the term:
(a) "Ambulance" means any vehicle that is intended to be used for and is maintained or operated for transportation of persons who are sick, injured, wounded or otherwise incapacitated.
(b) "Attendant" means a trained and qualified individual responsible for the operation of an ambulance and the care of the patients, whether or not the attendant also serves as driver.
(c) "Attendant-driver" means a person who is qualified as an attendant and a driver.
(d) "Driver" means an individual who drives or otherwise operates an ambulance.
(e) "Permit" means an authorization issued for an ambulance vehicle which meets the standards adopted pursuant to this chapter.
(f) "License" means an authorization to a person, firm, corporation or governmental division or agency to provide emergency medical services in the State.
(g) "Licensee" means any person, firm, corporation or governmental division or agency possessing authorization, permit, license or certification to provide EMS service in this State.
(h) "Certificate" means official acknowledgment by the Department that an individual has successfully completed one of the appropriate emergency medical technician training courses referred to in this chapter which entitles that individual to perform the functions and duties as delineated by the classification for which the certificate was issued.
(i) "Board" means the governing body of the Department of Health and Environmental Control or its designated representative.
(j) "Emergency medical service system" means the arrangement of personnel, facilities and equipment for the delivery of health care services under emergency conditions.
(k) "Emergency medical technician" (technician) means an individual possessing a valid certificate issued pursuant to the provisions of this chapter.
(l) "Standards" means the required measurable components of an EMS system having permanent and recognized value which provide adequate emergency health care delivery.
(m) "Authorized agent" means any individual designated to represent the Department.
(n) "Patient" means an individual who is sick, injured, wounded or otherwise incapacitated or helpless.
(o) "Operator" means an individual, firm, partnership, association, corporation, company, group or individuals acting together for a common purpose or organization of any kind, including any governmental agency other than the United States.
(p) "Department" means the administrative agency known as the Department of Health and Environmental Control.
(q) "National Registry of Emergency Medical Technicians license" means that an individual has passed a technician's examination in his state of residence, meeting the minimum training requirements deemed necessary, and is a member of the National Registry of Emergency Medical Technicians.
(r) "In-service training" means a course of training approved by the department that is conducted by the licensed provider for his personnel at his prime location.
(s) "Convalescent vehicle" means a vehicle that is used for making nonemergency calls such as scheduled visits to a physician's office or hospital for treatment, routine physical examinations, x-rays or laboratory tests, or is used for transporting patients upon discharge from a hospital or nursing home to a hospital or nursing home or residence, or other nonemergency calls.
(t) "EMT First Responder Agency" means a licensed agency providing medical care at the EMT Basic level or above, as a nontransporting first responder.
Standards and regulations for improvement of emergency medical services; creation and membership of Emergency Medical Services Advisory Council.
(a) The Department of Health and Environmental Control, with the advice of the Emergency Medical Services Advisory Council, shall develop standards and prescribe regulations for the improvement of emergency medical services (hereinafter referred to as EMS) in the State. All administrative responsibility for this program is vested in the department.
(b) The EMS program shall include:
(1) the regulation and licensing of public, private, volunteer, or other type ambulance services; however, in developing these programs for regulating and licensing ambulance services, the programs must be formulated in such a manner so as not to restrict or restrain competition;
(2) inspection and issuance of permits for ambulance vehicles;
(3) the licensing of EMT first responder agencies;
(4) training and certification of EMS personnel;
(5) development, adoption, and implementation of EMS standards and state plan;
(6) the development and coordination of an EMS communications system; and
(7) designation of trauma centers and the categorization of hospital emergency departments.
(c) An Emergency Medical Services Advisory Council must be established composed of representatives of the Department of Health and Environmental Control, the South Carolina Medical Association, the South Carolina Committee on Trauma, the South Carolina Hospital Association, the South Carolina Heart Association, Medical University of South Carolina, University of South Carolina School of Medicine, South Carolina College of Emergency Physicians, South Carolina Emergency Nurses Association, Emergency Preparedness Division of the Office of the Adjutant General, South Carolina Emergency Medical Services Association, State Board For Technical and Comprehensive Education, Governor's Office of Highway Safety, Department of Health and Human Services, four regional Emergency Medical Services councils, and one EMT first responder agency. Membership on the council must be by appointment by the board. Three members of the advisory council must be members of organized rescue squads operating in this State, three members shall represent the private emergency services systems, and three members shall represent the county emergency medical services systems.
Required licenses and permits; applications therefor; appeals; renewals.
(a) No person, firm, corporation, association, county, district, municipality, or metropolitan government or agency, either as owner, agent, or otherwise, shall furnish, operate, conduct, maintain, advertise, or otherwise engage in or profess to engage in the business or service of providing EMT first response or ambulance service, or both, without obtaining a valid license and ambulance permit issued by the department.
(b) Initial license applications shall be filed with the appropriate official of the Department having authority over emergency services. As a minimum, license applications shall contain evidence of ability to conform to the standards and regulations established by the Board and such other information as may be required by the Department. Upon receipt of the application, the Department official shall approve the application if the applicant demonstrates ability to conform to the duly published standards and regulations within thirty days. If the application is approved, the license shall be issued. If the application is disapproved the applicant shall have the right to appeal such decision to the Board within thirty days after receiving the notice required below. The Department official shall notify the applicant in writing of the reasons for such disapproval and of his right to appeal to the Board. If the applicant appeals to the Board, the decision to grant or deny the license application shall be by majority vote of the total membership of the Board at a full evidentiary hearing to be conducted within thirty days from receipt of the applicant's appeal. The decision of the Board shall be mailed to the applicant within thirty days after the hearing together with a statement as to the reasons for denial in the event the Board denies such appeal. Such decision shall constitute final administrative action and be subject to review by the circuit court upon petition filed by the applicant with the court and a copy thereof served upon the secretary of the Board within thirty days from the date of delivery of the decision of the Board to the applicant.
(c) License and permits shall be renewable every two years, upon compliance with Section 44-61-80(d).
Hereafter, no vehicle may be operated as an ambulance, except its licensed owner apply for and receive an ambulance permit issued by the Department for that vehicle. Prior to issuing an original permit for an ambulance, the vehicle for which the permit is issued shall meet all requirements as to vehicle design, construction, staffing, medical and communication equipment and supplies, and sanitation as set forth in this chapter or in the standards and regulations established by the Board. Permits issued for ambulances shall be valid for a period not to exceed two years.
Ambulance equipment requirements.
(a) Such equipment as deemed necessary by the Department of Health and Environmental Control shall be required of organizations applying for ambulance permits. Each licensee of an ambulance shall comply with such regulations as may be promulgated by the Board and shall maintain in each such ambulance at all times, when it is in use as such, all such equipment as may be prescribed by the Board.
(b) The transportation of patients and the provision of emergency medical services shall conform to standards adopted by the Board.
First responder licensing requirements
Organizations applying for first responder licensure must comply with equipment, training, and certification standards and other requirements promulgated by the department in regulation.
Procedure for suspension or revocation of license or permit; penalty.
(a) The appropriate official of the department having authority over emergency services shall have authority to recommend suspension of the license, certificate or permit of any person, firm, corporation, association, county, district, municipality or metropolitan government or agency for noncompliance with this chapter or the standards or the rules and regulations promulgated pursuant thereto.
The department official, if he has reason to believe that reasonable grounds exist, shall recommend to the board the suspension or revocation of the authorization, license, permit or certification of the licensee and shall notify the licensee of his recommendation not less than thirty days before the board shall consider such recommendation. The notice shall specify the alleged grounds therefor and the licensee shall be offered an opportunity to be heard at the hearing of the board in answer thereto. The board, at a full evidentiary hearing, shall determine whether or not the authorization, license, permit or certification shall be suspended or revoked. The decision to suspend or revoke shall be by majority vote of the total membership of the board. Such decision shall constitute final administrative action and shall be subject to review by the Circuit Court upon petition filed with the court and a copy thereof served upon the secretary of the board within thirty days from the date of delivery of the decision of the board from which such person is appealing.
No suspension or revocation of a license, authorization, permit or certification shall be effective until such time as the question of suspension or revocation has been finally resolved and if a decision of the board is appealed in court, no such suspension or revocation shall be effective until a final court determination is made. Provided, however, that if the Director of the Department of Health and Environmental Control determines that a clear and present danger would exist to the public health, safety or welfare if the license, authorization, permit or certification were not immediately suspended or revoked, the suspension or revocation shall be immediate.
(b) Grounds for revocation or suspension of an authorization, license, permit or certification shall exist for violation of any rule or regulation prescribed by the Board if such rule or regulation has been duly filed with the Secretary of State.
(c) Whoever hinders, obstructs or interferes with an officer, inspector or duly authorized agent of the Department while in the performance of his duties or violates any provision of this chapter or rule or regulation of the Board promulgated pursuant thereto shall be deemed guilty of a misdemeanor and, upon conviction, shall be punished by a fine of not less than fifty dollars nor more than two thousand dollars or by imprisonment for not less than ten days nor more than six months for each offense. Any certificate of the Department in regard to the records of the Department shall be admissible in evidence in all prosecutions under this chapter.
Emergency medical technician certificate; suspension or revocation of certificates.
(a) All ambulance attendants shall obtain a valid emergency medical technician certificate unless an exception is granted pursuant to regulations promulgated by the department.
(b) The Department shall develop and approve curricula for the necessary classification of emergency medical technicians and approve the training program for the necessary classifications of emergency medical technicians.
(c) Any person desiring certification as an emergency medical technician must complete the appropriate emergency medical technician course and apply to the Department. The Department shall make a determination of the applicant's qualifications and shall issue the appropriate certificate to the applicant. The National Registry of Emergency Medical Technicians licenses shall be acceptable to obtain a state emergency medical technician's certificate.
(d) A certificate is valid for a period not exceeding three years from the date of issuance and may be renewed every three years from the date of original certification subject to the holder completing a refresher course and examination during the three-year certification period as required by the department and provided for by this chapter. Upon successful completion of an approved in-service training program directed by the medical control physician during the three-year certification period and passage of the skills evaluation as provided for by the department, the refresher course requirements and the practical skills evaluation may be waived. Failure to pass the written examination after two attempts will require completion of the refresher course and reexamination. The curriculum for in-service training programs required in this subsection shall include but not be limited to subject matter prescribed by the department. The in-service training programs shall consist of classroom and skills phases that may be conducted at ambulance services, educational facilities, or hospitals throughout the State. The medical control physician who evaluates the skills of an emergency medical technician applying for certificate renewal may also grant a waiver of taking the written exam. The waiver must certify that the emergency medical technician is knowledgeable, proficient, and capable of performing the duties of an emergency medical technician. The accomplished waiver substitutes for the written exam, and all others are required to take the prescribed written exam before renewal.
(e) The department shall suspend or revoke a certificate so issued at any time it is determined that the holder no longer meets the prescribed qualifications set forth by the department or has failed to provide to patients emergency medical treatment of a quality deemed acceptable by the department or is guilty of misconduct as outlined by the rules and regulations.
(f) All instructors of emergency medical technician training courses shall be certified by the Department pursuant to requirements established by the Board; and all such training courses shall be supervised by certified instructors.
Records shall be kept by ambulance service licensees.
Each licensee shall maintain records that include approved patient care report forms, employee/member rosters, time sheets, call rosters, and training records. These records must be available for inspection by the department at any reasonable time and copies must be furnished to the department upon request.
The following are exempted from the provisions of this chapter:
(a) Ambulances owned and operated by the Federal Government.
(b) A vehicle or vehicles rendering assistance to community ambulances in the case of a catastrophe when licensed ambulances in the locality are insufficient to render the required services.
(c) The use of a privately or publicly owned vehicle, not ordinarily utilized in the transportation of persons who are sick, injured or otherwise incapacitated and operating under the provisions of Section 15-1-310 (Good Samaritan Act) in the prevention of loss of life and alleviation of suffering.
Size requirements and exemptions for convalescent transport units.
The governing body of any county may exempt, by ordinance, any ambulances used primarily as convalescent transport units from the size provisions of this chapter or any regulations relating to size requirements promulgated pursuant to this chapter.
Any vehicle which does not meet the size requirements named in federal specification KKK-A-1822 may be used as a convalescent transport unit provided it meets the following requirements:
1. There shall be no restrictions concerning the painted color of convalescent transport units.
2. No emblems or markings detailed in Section 7-V(A) of Regulation 61-7 of the department may be employed by convalescent transport units, except that the name of the operating company or organization shall be allowed on the vehicle.
3. (a) The minimum inside length from the back of the driver's seat to the closed rear door of the vehicle is one hundred eight inches.
(b) The minimum inside width is sixty-six inches from window to window.
(c) The minimum inside height from floor to ceiling is fifty-two inches.
4. (a) Rear doors shall swing clear of the opening to permit full access to the patient compartment.
(b) All patient compartment doors shall incorporate a holding device to prevent the door closing unintentionally from wind or vibration. When doors are open the holding device shall not protrude into the access area.
(c) The spare tire shall be secured and stored in such a position that it may be removed without disturbing the patient.
5. (a) Lighting must be available for both the driver and an attendant, if riding in the driving compartment, to read maps, records, etc. There must be shielding of the driver's area from the lights in the patient compartment.
(b) Illumination must be sufficient throughout the compartment for adequate observation of vital signs, such as skin color and pupillary reflex, and for care in transit. Controls will be located in the patient compartment.
6. (a) There shall be at least one flood light mounted above the rear door of the vehicle.
(b) Convalescent transport units are prohibited from using emergency lights. Yellow warning lights may be installed, however, with use limited to emergencies that may develop while transporting convalescent patients.
7. All safety factors for the patient compartment detailed in Section 7-V(A) 10 of Regulation 61-7 of the department shall be employed by convalescent transport units with the exception of 7-V(A)10(a).
8. All environmental equipment and specifications detailed in Section 7-V(A)11 of Regulation 61-7 of the department shall be employed by convalescent transport units with the exception that there need not be separate heating and air conditioning controls in the patient compartment unless a bulkhead or other physical boundary prevents adequate circulation.
9. A spare wheel with appropriate size, inflated, mounted tire shall be provided in addition to a jack and wheel lug wrench.
10. Convalescent transport units shall have storage cabinets of sufficient size and configuration to store all required equipment. All equipment must be accessible to the attendant at all times.
11. All convalescent transport units are prohibited the use of any siren or public address system.
12. All windows, windshield and door glass must be shatterproof.
13. Convalescent transport units must be equipped with the minimum ambulance medical equipment detailed in Section 7-VI of Regulation 61-7 of the department.
14. There must be at least one certified Emergency Medical Technician in the patient compartment each time a patient is transported.
Nothing in this section shall be interpreted as prohibiting those ambulances meeting the requirements of federal specification KKK-1822 from operating as both convalescent and emergency vehicles.
Restriction on financial aid.
No financial grants or funds administered by the State for emergency medical services pertinent to this chapter shall be made available to counties or municipalities not in compliance with the provisions of this chapter.
Plan shall be developed.
The Department shall develop a comprehensive statewide emergency medical services plan to implement and insure the delivery of adequate emergency medical services to every citizen.
Authority of emergency medical technicians.
A duly certified emergency medical technician may perform any function consistent with his certification, according to such rules and regulations as the board may prescribe.
Emergency Medical Technicians, trained to provide advanced life support and possessing current Department of Health and Environmental Control certification, are authorized to possess limited quantities of drugs, including controlled substances, as may be approved by the Department of Health and Environmental Control for administration to patients during the regular course of duties of such Emergency Medical Technicians, pursuant to the written or verbal order of a physician possessing a valid license to practice medicine within this State provided such physician is registered under the State and federal laws pertaining to controlled substances.
Chapter shall not affect present rescue units.
Nothing in this chapter may be construed as limiting presently operating rescue units from utilizing their existing equipment and performing the functions they are now allowed to do so long as they do not conflict with licensed agencies contained in subsection (a) of Section 44-61-40.
Rules and regulations shall be filed.
All rules and regulations promulgated by the Board shall be filed with the Secretary of State.
EMERGENCY MEDICAL SERVICES FOR CHILDREN
This article may be cited as the Children's Emergency Medical Services Act.
As used in this article:
(1) "Advanced life support" means an advanced level of pre-hospital, interhospital, and emergency service care which includes basic life support functions, cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of antiarrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care, and other techniques and procedures authorized by the department pursuant to regulations.
(2) "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 department pursuant to regulations.
(3) "Coordinator" means the person coordinating the EMSC Program within the Department of Health and Environmental Control.
(4) "Department" means the Department of Health and Environmental Control.
(5) "Director" means the director of the Department of Health and Environmental Control.
(6) "EMSC Program" means the Emergency Medical Services for Children Program established pursuant to this article and other relevant programmatic activities conducted by the department in support of appropriate treatment, transport, and triage of ill or injured children.
(7) "Emergency medical services personnel" means persons trained and certified or licensed to provide emergency medical care, whether on a paid or volunteer basis, as part of a basic life support or advanced life support pre-hospital emergency care service or in an emergency department or pediatric critical care or specialty unit in a licensed hospital.
(8) "Pre-hospital care" means the provision of emergency medical care or transportation by trained and certified or licensed emergency medical services personnel at the scene of an emergency and while transporting sick or injured persons to a medical care facility or provider.
Establishment of program.
There is established within the Department of Health and Environmental Control, Division of Emergency Medical Services, the Emergency Medical Services for Children Program.
Scope of program; gathering of data.
(A) The EMSC Program shall include, but is not limited to, the establishment of:
(1) initial and continuing education programs for emergency medical services personnel that include training in the emergency care of infants and children;
(2) guidelines for referring children to the appropriate emergency treatment facility;
(3) pediatric equipment guidelines for pre-hospital care;
(4) pediatric equipment guidelines for emergency departments;
(5) guidelines for pediatric trauma centers;
(6) an interhospital transfer system for critically ill or injured children;
(7) in conjunction with the South Carolina Data Oversight Council, the collection and analysis of statewide pediatric emergency and critical care medical services data from emergency and critical care medical services for the purpose of quality improvement by these facilities and services, subject to the confidentiality requirements of Section 44-61-350;
(8) injury prevention programs for parents;
(9) public education programs on accessing the emergency medical services system and what to do until the emergency medical services personnel arrive.
(B) In gathering statewide pediatric emergency and critical care medical services data, the department shall rely upon, to the extent possible, data from existing sources; however, the department may contact families and physicians for the purpose of gathering additional data and providing information on available public and private resources. Information requested from a physician's office must be obtained pursuant to Chapter 115. Patient contact following data received from the State Budget and Control Board Office of Research and Statistics must be done in accordance with regulations approved by the South Carolina Data Oversight Council and promulgated by the Office of Research and Statistics.
Confidentiality; civil and criminal liability; restrictions on release of information; violations and penalties.
(A) The identities of patients, emergency and critical care medical services personnel, and emergency and critical care medical services facilities mentioned, referenced, or otherwise appearing in information or data collected or prepared by or in connection with the EMSC Program must be treated as strictly confidential. The identities of these persons or entities are not available to the public under the Freedom of Information Act or discoverable or admissible in any administrative, civil, or criminal proceeding. An individual in attendance at any such proceeding may not be required to testify as to the identity of any such person or entity. No person, medical facility, or other organization providing or releasing information in accordance with this article may be held liable in a civil or criminal action for divulging confidential information unless the individual or organization acted in bad faith or with malicious purpose.
(B) The identity of a patient, physician, or hospital is confidential and may not be released except that the identity of a patient may be released upon informed written consent of the patient or the patient's legal guardian or legal representative; the identity of a physician may be released upon written consent of the physician; and the identity of a hospital may be released upon written consent of the hospital.
(C) Information must not be released except to:
(1) appropriate staff of the Division of Emergency Medical Services within the Department of Health and Environmental Control, South Carolina Data Oversight Council, and State Budget and Control Board, Office of Research and Statistics;
(2) submitting hospitals or their designees;
(3) a person engaged in an approved research project, except that no information identifying a subject of a report or a reporter may be made available to a researcher unless consent is obtained pursuant to this section.
(D) For purposes of maintaining the data base collected pursuant to this article, the department and the Office of Research and Statistics may both access and provide access to appropriate confidential data reported in accordance with Section 44-6-170.
(E) A person subject to this article who intentionally fails to comply with reporting, confidentiality, or disclosure requirements of this article is subject to a civil penalty of not more than one hundred dollars for a violation the first time a person fails to comply and not more than five thousand dollars for a subsequent violation.