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LAW AND REGULATION
The regulatory environment of EMS is largely shaped by state and local policy. While the federal government provides significant leadership and guidance through a mix of federal agencies, it is most often state law and regulation that dictates the scope, authority, and operation of local EMS systems. 30 While these may vary significantly from state to state, similar issues arise as potential barriers or challenges to EMS innovation.
LEGAL & REGULATORY BARRIERS TO EMS INNOVATION LIMITED TO EMERGENCIES ONLY
as new evidence emerges, 31 it is often misused as a ceiling for the scope of practice of EMS professionals and, in some cases, state laws and/ or regulations codify which skills, treatments, or assessments may be performed by the providers. As a result, changing EMS protocols or adding new technologies or skills to keep pace with evidence may be hindered. Furthermore, the ability to test new ideas in order to establish evidence may be impaired. Particular scope of practice issues that seem to be most affected by local statutes include the ability to transport to alternative destinations, to treat without transport, and non-emergency visits. BURDENSOME PROCESSES TO APPROVE PILOT PROGRAMS Many of these new or expanded roles for EMS providers have the potential to be very beneficial to patients, as well as to primary care physicians, emergency medicine specialists and others. In order to test their efficacy, a number of pilot programs have been initiated. Unfortunately, the process by which many of these pilots were initiated proved to be overly burdensome, and in some cases, pilot programs required legislative
Legal barriers to EMS innovation vary from outright prohibition of non-traditional uses of EMS to the more common situation of incomplete, outdated, or conflicting laws that fail to address or allow for new technologies, care pathways, or new roles such as community paramedicine or mobile integrated health care. Many state governments and state EMS offices seem to have taken the position that if it is not explicitly authorized, it is prohibited. There is little to no case law testing this assumption with regards to EMS programs, leaving most EMS innovators in an uncomfortable position of uncertainty. Similarly, where there is no legislation, there are rarely policy statements or other forms of clear guidance either allowing or prohibiting expanded roles for EMS providers or systems. SCOPE OF PRACTICE While the National EMS Scope of Practice Model (2007) sought to establish minimum competencies that should be constantly reviewed and revised
30 “Emergency Medical Services at the Crossroads.” In Future of Emergency Care Series edited by Gail L. Warden. Washington, D.C.: Institute of Medicine, 2006. 31 “National EMS Scope of Practice Model.” National Highway Traffic Safety Administration . Last modified February 2007. https://www.ems.gov/education/EMSScope.pdf.
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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