FIGURE 6:
WA
States with EMS law or regulation providing peer review protection.
ME
MT
ND
VT
OR
MN
NH
Source: National EMS Assessment (2011). NHTSA.
WI
ID
NY
SD
MA CT
RI
MI
WY
PA
IA
NE
MD DE NJ
NV
IN OH
IL
UT
WV
CO
VA
KS
CA
MO
KY
NC
TN
OK
AZ
SC
AR
NM
GA
MS
AL
AK
LA
TX
FL
Yes No
HI
action. 32 The ability for EMS to innovate, including developing, experimenting, and testing of new ideas, is greatly diminished by the amount of time and effort needed to obtain legislative approval of a pilot program. Further, for successful programs, there is not necessarily a clear process to change their status from pilot to permanent. LACK OF LIABILITY PROTECTIONS Pilot programs are further inhibited by a lack of liability protections and inadequate protection of quality assurance activities. However, the ability to improve the everyday care provided by EMS to the public is inhibited by a general lack of protection of peer review or quality assurance communications. According to the 2011 National EMS Assessment, 35 states lack general liability protection for providers or agencies, and 23 states lack any regulation or statute providing protection for peer review for the purpose of continuous quality improvement. 33 Even among those states with regulations or statutes in place, those protections are often weak, sometimes only protecting communications within the agency and not those between agencies or between hospitals and EMS.
PORTABILITY OF CERTIFICATION An issue related to scope of practice is the lack of portability of licensure and/or certification. The lack of standardization of education, licensure, and protocols across jurisdictions makes it difficult for EMS providers to migrate across borders during large-scale events. Independent of the interstate variations, there seem to be excessive bureaucratic hurdles and insufficient planning on the part of many localities to consider how to rapidly integrate EMS providers across regions within the same state or across state borders. Although the EMAC (Emergency Management Assistance Compact) addresses this hurdle, it only applies to disasters for which an affected state’s governor declares a state of emergency. In addition, there are frequently restrictions on the application of a provider’s skills based on the setting of care. For example, in some states, an EMS provider may not perform certain skills inside a hospital that they are authorized to perform outside of a health care facility. This adversely impacts a community’s ability to maneuver health care resources and to care for patients as they move between settings.
32 Karen Pearson, George Shaler “Community Paramedicine Pilot Programs: Lessons from Maine.” Journal of Health and Human Services Administration 40, no. 2 (2017). 33 “National EMS Assessment.” National Highway Traffic Safety Administration . Last modified December 2012. https://www.ems.gov/pdf/2011/National_EMS_Assessment_Final_Draft_12202011.pdf.
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CHAPTER 2
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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