A3795 CONAWAY 2. AN ACT concerning the operation of air ambulance services and supplementing Title 26 of the Revised Statutes.

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1 ASSEMBLY, No. STATE OF NEW JERSEY th LEGISLATURE INTRODUCED DECEMBER, 00 Sponsored by: Assemblyman HERB CONAWAY, JR. District (Burlington and Camden) SYNOPSIS Establishes procedures for operation of air ambulance services. CURRENT VERSION OF TEXT As introduced.

2 A CONAWAY AN ACT concerning the operation of air ambulance services and supplementing Title of the Revised Statutes. BE IT ENACTED by the Senate and General Assembly of the State of New Jersey:. As used in this act: "Advanced life support" or ALS means an advanced level of pre-hospital, inter-hospital, and emergency service care as defined by regulation of the commissioner. "Air ambulance service" means an entity licensed by the department to provide advanced life support to accident and trauma victims by means of a specially equipped and specially staffed air medical unit. "Air ambulance service medical staff" means an employee of an air ambulance service who provides medical treatment or assistance to patients. Air medical unit or AMU means a specially equipped helicopter that is operated as an air medical service and is licensed by the department pursuant to P.L., c. (C.:K- et seq.) or P.L., c.0 (C.:K- et seq.). AMU dispatch means the request for emergency medical transportation by air ambulance service of a victim of an accident or trauma by a central communications center in accordance with the protocols set forth in section of this act. AMU dispatch shall not include a request for medical transportation by an air ambulance service when the request involves transportation from one licensed health care facility to another. AMU Responder means an air ambulance service that has been contacted for AMU dispatch and has verified its ability to arrive at the scene of the accident or trauma within 0 minutes of the AMU dispatch in accordance with the protocols set forth in section of this act. Central communications center means the single center responsible for coordinating all dispatch requests made by regional communications centers and implementing a dispatch pursuant to this act. "Commissioner" means the Commissioner of Health and Senior Services. "Department" means the Department of Health and Senior Services. "Emergency medical transportation" means the prehospital or interhospital transportation of an acutely ill or injured patient. Global Positioning System or GPS means the Global Positioning System required to be utilized by the central communications center for the dispatch of AMU services in accordance with the provisions of this act. Medical command/amu means the medical direction provided

3 A CONAWAY to AMU crew members by a medical command physician in accordance with criteria applicable to AMUs set forth by regulation of the commissioner. Medical Command Physician/AMU means a physician licensed by the State Board of Medical Examiners who meets criteria set forth by regulation of the commissioner to provide medical direction to AMU crew members by radio, telephone, or other direct means of communication. "Medical transportation" means the transportation of a patient to or from medical treatment, and includes emergency medical transportation. Mobile intensive care program means a program that is operated by an acute care hospital licensed by the department, in accordance with a certificate of need issued, pursuant to P.L., c. (C.:H- et seq.), which provides pre-hospital ALS by means of a specially equipped and staffed mobile intensive care unit. Mobile intensive care unit or MICU means a specialized emergency medical services vehicle operated under the medical command of a mobile intensive care program pursuant to P.L., c. (C.:K- et seq.). Regional communications center means a center that provides coordinated requests for emergency medical transportation in accordance with the requirements of this act and the rules and regulations adopted by the commissioner pursuant to this act.. a. Notwithstanding the provisions of any other law to the contrary, the commissioner shall certify an air ambulance service to operate as an AMU Responder in this State if the air ambulance service: () is licensed and operated in compliance with all applicable provisions of Title of the Revised Statutes; () is operated under the medical command/amu of a mobile intensive care program; and () is licensed as an air medical service in compliance with the air ambulance service regulations of the department. b. If an AMU submits a written request to the department for AMU Responder certification and that request is not affirmatively denied by the department within 0 days after its receipt of the written request, the AMU shall be deemed to be certified by the commissioner. c. Nothing in this act shall prohibit a hospital-based emergency medical service helicopter response unit designated by the commissioner pursuant to P.L., c.0 (C.:K- et seq.) from operating as an AMU Responder if it meets the requirements for certification set forth in this section. d. The commissioner shall maintain a registry of all certified AMU Responders and shall ensure the registry is updated on a

4 A CONAWAY monthly basis and provided to the central communications center. The registry shall be made available to the public. The registry shall include: () the name and address of each certified AMU Responder; () a list of written requests for certification and the date that each request was made; and () a list of any requests for certification that have been denied by the commissioner, the reasons for denial, and whether the denial is being appealed. e. The commissioner, after notice and hearing, may revoke the certification of an AMU Responder for failure to comply with the requirements for certification set forth in this section.. The commissioner shall require the central communications center to utilize GPS for tracking the location and flight status of all AMU Responders and to implement an AMU dispatch system as set forth in this section. The dispatch system shall provide accident and trauma victims with timely access to needed AMU services by utilizing all available New Jersey trauma care resources in order to improve patient outcomes in accordance with the following dispatch protocols: a. Upon receipt of initial notification of the need for ALS services at the scene of an accident or trauma, the regional or central communications center receiving that notification shall document the estimated time of the accident or trauma, as well as the time of notification of the need for ALS services; b. If a regional communications center receives a request for AMU services, it shall immediately communicate the request to the central communications center. The regional or central communications center shall document the time of its receipt of any request for AMU services, and shall document whether ALS services have been previously dispatched to the scene; c. The central communications center shall utilize GPS to identify the geographic location of the accident or trauma scene, as well as the geographic location and flight status of all AMU Responders, including NorthSTAR or SouthSTAR, and shall contact the AMU Responder that is identified as being the geographically closest, as measured by the distance, in miles, between the geographic location of the accident or trauma scene and the geographic location of the AMU Responder at the time of the request for AMU services when measured in a straight line, to the accident or trauma scene; d. In the event that two or more AMU Responders are identified as being equal in terms of being geographically closest, in terms of estimated total flight time, to the accident or trauma scene, and one of the AMU Responders is NorthSTAR or SouthSTAR, then NorthSTAR or SouthSTAR, as appropriate, shall be deemed to be the geographically closest AMU Responder and shall be the first

5 A CONAWAY AMU Responder contacted by the central communications center. e. Once an AMU Responder is dispatched to the accident or trauma scene, the central communications center shall document the time of AMU dispatch, and the AMU Responder shall notify the central communications center upon its arrival at the scene. The AMU Responder shall also notify the central communications center of any cancellations of the request for its services, whether such cancellation is received en route to the scene or upon arrival at the scene, and of the reason for such cancellation. The central communications center shall document: the time of arrival by the AMU Responder at the accident or trauma scene, the time of any cancellation of the request for AMU services, and the reason for any such cancellation. f. An AMU Responder shall not charge an uninsured patient an amount for AMU services that exceeds the amount reimbursed by the federal Medicare program established pursuant to Title XVIII of the federal Social Security Act, Pub.L.- ( U.S.C. s. et seq.), for those services. g. All documentation required pursuant to this section shall be maintained by the central communications center for a period of no less than two years and shall be made available to the public upon request.. The Commissioner of Health and Senior Services, pursuant to the "Administrative Procedure Act," P.L., c.0 (C.:B- et seq.), shall adopt rules and regulations to effectuate the purposes of this act.. This act shall take effect on the 0th day from the date of enactment, but the Commissioner of Health and Senior Services may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act. STATEMENT This bill improves the current air ambulance dispatch system in New Jersey by requiring the utilization of a global positioning system to identify and locate the closest available licensed air ambulance service, and by establishing dispatch procedures that ensure the most timely response to the scene of an accident or trauma. Currently, New Jersey s emergency dispatch system for air ambulance services limits initial dispatch to one of two Statedesignated air ambulance units, NorthSTAR and SouthSTAR. This bill would allow other licensed air ambulance providers to respond to the scene of an accident or trauma, so that accident and trauma victims requiring air ambulance transport can access this service in the most timely manner possible.

6 A CONAWAY When New Jersey s emergency air ambulance program (JEMSTAR) was created in, emergency medical transportation services were lacking, particularly in rural areas. As noted in the Statement to Assembly Bill No. 0 of, which was enacted as P.L., c.0 (C.:K- et seq.), JEMSTAR was intended to provide a cost-effective emergency medical transportation service to residents of rural areas where mobile intensive care services are not available and for accident victims and critically ill persons for whom this service would be more appropriate than conventional ground transportation. The emergency medical service landscape in New Jersey was vastly different in than it is today. In, no air ambulance services were licensed to operate in New Jersey, adequate mobile intensive care unit services provided by ground ambulance were lacking in certain areas of the State, and only two New Jersey hospitals provided acute trauma services. Today, 0 New Jersey hospitals, which are geographically dispersed throughout the State, are licensed by the Department of Health and Senior Services to provide definitive trauma care, regardless of the severity of the injury as Level I or Level II trauma centers, and there are mobile intensive care unit programs operating in 0 counties. When an accident or trauma victim requires emergency medical transportation by way of air ambulance service, the current protocol requires that NorthSTAR or SouthSTAR be called by the central communications center. Only when one of these two designated air ambulance services refuses the dispatch (either at the time of initial contact by the central communications center or at some time subsequent to an initial acceptance of the dispatch) does the dispatch system permit another licensed air ambulance service provider to respond. Valuable minutes can be lost because the current dispatch system fails to call upon the geographically closest, most-immediately available licensed air ambulance service. Thus, the current dispatch system jeopardizes the health and safety of accident and trauma victims whose outcomes or lives may depend upon getting transport to a trauma center as quickly as possible. The New Jersey Emergency Medical Service Helicopter Response Program Fund was established under section of P.L., c. (C.:K-.) to provide a dedicated funding source administered by the State Treasurer to support the reasonable and necessary expenses of JEMSTAR, and requires the Commissioner of Health and Senior Services to report, to the Joint Budget Oversight Committee and the Senate and Assembly standing reference committees on health, cost analyses concerning JEMSTAR activities, including the number of flights, types of accidents, hours spent waiting at accident sites, and fuel and maintenance expenses. A report to the Joint Budget Oversight Committee for the period from January, 00 through June 0, 00 was issued in August

7 A CONAWAY of 00, and set forth Average PreHospital Mission Waiting Times for NorthSTAR and SouthSTAR of minutes for Not Entrapped trauma victims and minutes for Entrapped trauma victims, but did not specify whether these average waiting times are measured from the time of the initial trauma to the arrival of NorthSTAR or SouthSTAR on the scene, from the time of dispatch of NorthSTAR or SouthSTAR to arrival at the scene, or from the time of arrival at the scene to successful transport to the appropriate trauma facility. The goal in trauma care is to get seriously injured patients to an appropriate level trauma center for diagnosis, critical care, and surgical treatment within the Golden Hour (the first hour immediately following an accident or trauma), and to get the seriously injured patient into an appropriate trauma center with an experienced team of specialized trauma physicians and surgeons within the Golden Hour requires a highly efficient and effective trauma care system. Additionally, ensuring that patients receive appropriate trauma care within the Golden Hour requires identification and documentation of the following time periods: ()the time between crash occurrence and notification of an emergency medical service; () the travel time to the crash scene by the emergency medical service following notification; () the time spent by the emergency medical service at the scene in rescue activities and the initiation of pre-hospital care; () the time between crash occurrence and notification of the centralized dispatch center for dispatching NorthSTAR or SouthSTAR, if required; () the time between the dispatch of NorthSTAR or SouthSTAR and arrival at the accident scene; () the time spent by NorthSTAR or SouthSTAR at the scene in loading the patient onto the air ambulance unit; () the time required to travel from the accident or trauma scene to the trauma center, and () the time spent at the trauma center unloading the patient and admitting the patient to the emergency department at the trauma center. Finally, the American College of Emergency Physicians has stated that, whenever possible, the time a trauma victim spends at the scene of an accident should be limited to 0 minutes or less. Therefore, this bill seeks to improve the quality of trauma care services to critically injured victims in New Jersey, not only by creating a more efficient and effective dispatch system, but by tracking and monitoring segments or response times in order to identify future system improvements.