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Proposed Emergency Health Services and Community Paramedicine Legislation

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Proposed Emergency Health Services and Community Paramedicine Legislation PROPOSED EMERGENCY HEALTH SERVICES AND COMMUNITY PARAMEDICINE LEGISLATION Discussion Guide 1 Introduction The Department of Health and Community Services is in the process of drafting legislation to govern the Provincial Road Ambulance Program (the program). Input from stakeholders and the public is an essential element in drafting this legislation as it will ensure it meets the needs of the ambulance industry and residents of the province. This document provides a brief overview of the program and the components that are being considered for inclusion in the new legislation. The document includes six areas for consideration, including the current state and changes being proposed. As we are inviting feedback, each section also includes specific questions and spaces for a response. There is also an opportunity for respondents to indicate any additional feedback at the end of the document. A glossary of terms used in this document can be found in Annex 1. Background Newfoundland and Labrador is the only jurisdiction in Canada without legislation governing the delivery of ambulance services. In 2012, the Department engaged an external consultant, Fitch and Associates, to conduct a review of the program, which involved stakeholder consultations both during and following the review. In the 2013 report, Fitch indicated numerous issues with the program, among them, a lack of consolidated legislation. Fitch expressed concern that multiple pieces of legislation and multiple organizations were responsible for different elements of the program. Fitch made 10 recommendations to government to transform the program into an efficient and effective ambulance service. One of the key recommendations was the development of dedicated emergency medical services legislation, so that one organization has the responsibility for ambulance service delivery and the authority to make changes necessary to improve the program. The full report can be found here: https://www.health.gov.nl.ca/health/publications/nl_ambulance_review.pdf 2 Overview of the Provincial Road Ambulance Program The program provides emergency and routine (inter-facility) patient transfers. Some key statistics for the program include: Approximately 80,000 transports were completed in fiscal year 2017-18. The Board of Commissioners of Public Utilities has issued 61 licenses to operate road ambulance services in the province as follows: o 13 are operated by regional health authorities (RHAs); o 26 are operated privately; and o 22 are operated by communities (not for profit). The 61 operators receive funding from the Provincial Government to operate a combined total of 179 ambulances throughout the province. 830 ambulance professionals are employed by the 61 operators. The provincial budget for the program was approximately $61.5 million in fiscal year 2017-18. At this time, components of the program are governed by the following statues and regulations: Health and Community Services Act; Highway Traffic Act and Ambulance, Bus, School Bus, Taxi and Commercial Motor Vehicle Insurance Regulations; Licensing and Equipment Regulations; Motor Carrier Act and Motor Carrier Regulations; and Regional Health Authorities Act and Regional Health Authorities Regulations. Links to all relevant legislation and regulations governing the program can be found in Annex 2. By virtue of the various pieces of legislation and regulations referenced above, the program is governed by multiple entities each with their own responsibilities: 3 o Department of Health and Community Services – Development of ambulance operating policies, ambulance standards and the negotiating of private and community ambulance operator contracts; o Board of Commissioners of Public Utilities (PUB) – Issuing of ambulance operator licenses called Motor Carrier Certificates; o Regional Health Authorities (RHAs) – Responsible for the day to day delivery of private and community ambulance services in their region as well as operating hospital-based ambulance services; o Provincial Medical Oversight Office – Responsible for licensing ambulance professionals, the development of medical protocols, and medical oversight; o Service NL (Highway Enforcement) – Ambulance vehicle registration and ambulance inspection; and o Service NL (Occupational Health and Safety) – Employee and patient safety as well as fatigue management oversight. Components of the Proposed Act It is envisioned that the proposed new legislation will consolidate responsibility for the program, in its entirety, to Health and Community Services. The Department may then delegate responsibilities to other organizations such as RHAs. Health and Community Services is proposing to include at least the following six elements in the new legislation: 1. Licensing of Ambulance Services 2. Identification of Ambulance Professional Qualifications 3. Medical Direction and Quality Assurance 4. Identification of Emergency Medical Vehicles 5. Establishing Medical Vehicle Standards 6. Operator Performance Standards and Responsibilities 4 1. Licensing of Ambulance Services Private and community ambulance operators are currently required to take two steps before they can operate a publically funded ambulance service: Step 1: Ambulance operators apply to the PUB for a license to provide ambulance services in a specific region of the province. The Motor Carrier Act assigns responsibility for the licensing of ambulance services to the PUB. A PUB license does not guarantee funding from the Department. Step 2: The Department of Health and Community Services contracts with a licensed operator for the provision of public ambulance services in a specific community or region. Funding is issued at the Department’s discretion. Health and Community Services is proposing to co-ordinate both ambulance licensing and ambulance contracting to ensure that ambulance operating licenses are assigned only to operators that have contracts in place with government. The Department is proposing that under the new legislation: Health and Community Services would assume responsibility for the licensing of ambulance services within the province; The PUB will no longer have responsibility for ambulance licensing; and Health and Community Services would have the authority to: o Identify an entity responsible for issuing licenses, reporting to the Department; and o Establish the process to issue and renew ambulance licenses. 5 Questions: Do you support combining the two functions of licensing and funding into one Department? Why or why not? What else should the Department consider for ambulance operator licensing? 6 2. Identification of Ambulance Professional Qualifications The proposed legislation would provide Health and Community Services with the authority to identify the skills and qualifications necessary for paramedics and other ambulance and emergency health professionals to provide care including emergency medical response, medical transport, community paramedicine programs, and industrial paramedicine services. The National Occupation Competency Profile for Paramedics identifies four skill/qualification levels: Emergency Medical Responder (EMR); Primary Care Paramedic (PCP); Advance Care Paramedic (ACP); and Critical Care Paramedic (CCP). In some jurisdictions, there are additional classifications of paramedics, medical first responders, and ambulance dispatchers. These classifications include Emergency Medical Responders, Emergency Medical Dispatchers, Medical Flight Specialists and Medical First Responders. Additional classifications are used to recognize specialized skills like dispatching and air transport. Additional classifications can also be used to recognize the skills and qualifications of ambulance attendants and first responders who are not formally trained as paramedics. Once the paramedic training and skill levels are identified, a process has to be established to determine if an individual is qualified to work at one of those skill levels. Health and Community Services is proposing that the new legislation would provide the Department with the authority to license or delegate the licensing of paramedics. 7 Questions: Do you have any concerns with what the Department is proposing? If yes, what are those concerns? What else should the Department consider for ambulance professional qualifications? 8 3. Medical Direction and Quality Assurance At this time, paramedics work under the license of a physician who provides them with the authority to practice. The care that paramedics are allowed to provide is at the discretion of the individual physician under whose license they practice. The physician develops a series of medical care protocols, which outlines the care to be provided under certain circumstances. At this time, paramedics who work for hospital-based, private and community operators work under the Medical Director of the Provincial Medical Oversight Office’s license. Paramedics working in private settings, including industrial sites, work under the authority of a physician contracted by the private company. Private sector paramedics provide care under the licenses of that privately contracted physician. Health and Community Services is proposing that the new legislation outline the medical care that paramedics can provide and grant the Department the authority to delegate responsibility for medical protocol development to a single Medical Director and their staff. The Medical Director would have responsibility to: Develop and maintain the medical protocols used by each level
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