As Reported by the Senate State and Local Government and Veterans Affairs Committee

126th General Assembly Regular Session 2005-2006

Sub. H. B. No. 375

Representatives Flowers, McGregor, J., Evans, D., Brown, Willamowski, Allen, Setzer, Patton, T., Stewart, D., Blessing, Cassell, Collier, Combs, Domenick, Fende, Hagan, Hughes, Mitchell, Otterman, Reidelbach, Smith, G., Widener, Williams, Wolpert, Yuko 

Senators Cates, Kearney, Fedor 

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A BILL

To amend sections 513.10, 749.18, 4765.05, 4765.11,

1

4765.16, 4766.01, 4766.03, 4766.04, 4766.06,

2

4766.07, and 4766.17 and to enact sections

3

4765.101, 4765.102, 4765.111, 4765.112, 4765.113,

4

4765.114, 4765.115, and 4765.116 of the Revised

5

Code concerning the authority of the State Board

6

of Emergency Medical Services to suspend

7

certificates to practice emergency medical

8

services, revisions to the law governing air

9

medical transportation, and qualifications and

10

residency requirements for members of a municipal

11

hospital board of governors.

12

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 513.10, 749.18, 4765.05, 4765.11,	13
4765.16, 4766.01, 4766.03, 4766.04, 4766.06, 4766.07, and 4766.17	14
be amended and sections 4765.101, 4765.102, 4765.111, 4765.112,	15
4765.113, 4765.114, 4765.115, and 4765.116 of the Revised Code be	16
enacted to read as follows:	17

Sec. 513.10. WhereIf an agreement under section 513.08 of	18
the Revised Code provides for representation of a joint township	19
hospital district, or of a county, on the board of hospital	20
commissioners or board of governors of a municipal hospital, or	21
both, suchthe representatives of the district shall be appointed	22
by the joint township district hospital board and shall be	23
electors of the district, and; in the case of a county, suchthe	24
representatives of the county shall be appointed by the board of	25
county commissioners and shall be electors of the county,or of an	26
adjacent county; and, in the case of membership on the board of	27
governors, at least one such elector, so appointed, shall be a	28
doctor of medicine. In the case of a joint township hospital	29
district, not more than one elector from any township included in	30
the district shall be appointed to either board unless each such	31
township has first had an elector thereofof that township	32
appointed to suchthat board.	33

District or county representatives appointed to sucha board	34
of hospital commissioners shall serve until the duties of the	35
board, pursuant to sections 749.06 to 749.14, inclusive, of the	36
Revised Code, have terminated.	37

District or county representatives on the board of governors	38
of sucha municipal hospital shall be appointed in the following	39
manner:	40

(A) When the terms of the members presently holding office	41
expire, of those first appointed thereafter:	42

(1) One shall be appointed for a term of one year;.

43

(2) One shall be appointed for a term of two years;.

44

(3) One shall be appointed for a term of three years;.

45

(4) If there are more than three are to be appointed, the	46
remaining appointments shall be for a term of four years.	47

(B) Thereafter, as the respective terms expire, appointments	48
shall be made in each case for a term of four years.	49

(C) Any vacancy shall be filled by appointment in like manner	50
for the unexpired term of the original appointment.	51

The joint township district hospital board, or the board of	52
county commissioners, may, by a majority vote of its members, may	53
remove any appointee to either board, for good and sufficient	54
cause, after a hearing upon written charges.	55

Sec. 749.18. WhereIf an agreement under section 749.16 of	56
the Revised Code concerns or includes participation of a joint	57
township hospital district, or of a county, in the maintenance and	58
operation of a municipal hospital, the municipal corporation may	59
establish a board of governors to exercise, subject to such	60
further limitations as are imposed by the agreement, the powers	61
vested in the board of hospital commissioners, provided that any	62
such limitations shall not deny the board of governors the	63
authority to retain counsel, to institute legal action in its own	64
name, or to employ any other lawful means, for the collection of	65
delinquent accounts. The board of governors may include in its	66
membership such representatives of thea participating district	67
who are electors of the district, or of thea participating county	68
who are electors of that county or an adjacent county, as are	69
provided for in suchthe agreement. The	70

Except as otherwise provided in this section, the municipal	71
members of the board of governors shall consist of the mayor, who	72
by virtue of that office shall be its president, and four resident	73
freeholders of the municipal corporation, at least one of whom	74
shall be a doctor of medicine, to be appointed by the mayor with	75
the consent of the legislative authority. However, if necessary to	76
secure qualified individuals to serve on the board of governors,	77
the municipal members of the board may be residents of the county	78
in which the municipal corporation is located or of an adjacent	79
county. The term of office of suchthose municipal members shall	80
be as provided in section 749.05 of the Revised Code. The	81

The board shallof governors, subject to the terms of the	82
agreement, shall establish such regulations and elect such	83
officers, other than president, as its members determine. The	84
members shall be entitled to suchthe compensation for their	85
services as is provided by the agreement.	86

Sec. 4765.05. (A) As used in this section, "prehospital	87
emergency medical services" means an emergency medical services	88
system that provides medical services to patients who require	89
immediate assistance, because of illness or injury, prior to their	90
arrival at an emergency medical facility.	91

(B) The state board of emergency medical services shall	92
divide the state geographically into prehospital emergency medical	93
services regions for purposes of overseeing the delivery of adult	94
and pediatric prehospital emergency medical services. These	95
regions shall consist of the same geographic regions as the health	96
service areas designated by the director of health under section	97
3702.58 of the Revised Code. For each prehospital emergency	98
medical services region, the state board of emergency medical	99
services shall appoint either a physician to serve as the regional	100
director or a physician advisory board to serve as the regional	101
advisory board. The state board of emergency medical services	102
shall specify the duties of each regional director and regional	103
advisory board. Regional directors and members of regional	104
advisory boards shall serve without compensation, but shall be	105
reimbursed for actual and necessary expenses incurred in carrying	106
out duties as regional directors and members of regional advisory	107
boards.	108

(C) Nothing in this section shall be construed to limit in	109
any way the ability of a hospital to determine the market area of	110
that hospital.	111

Sec. 4765.101. (A) The state board of emergency medical	112
services shall investigate any allegation that a person has	113
violated this chapter or a rule adopted under it.	114

Any person may submit to the board a written complaint	115
regarding an alleged violation of this chapter or a rule adopted	116
under it. In the absence of fraud or bad faith, no person	117
submitting a complaint to the board or testifying in an	118
adjudication hearing conducted in accordance with Chapter 119. of	119
the Revised Code with regard to such an alleged violation shall be	120
liable to any person in damages in a civil action as a result of	121
submitting the complaint or providing testimony.	122

(B) In investigating an allegation, the board may do any of	123
the following:	124

(1) Administer oaths;

125

(2) Order the taking of depositions;

126

(3) Issue subpoenas;

127

(4) Compel the attendance of witnesses and production of	128
books, accounts, papers, records, documents, and testimony.	129

(C) A subpoena for patient record information shall not be	130
issued without consultation with the attorney general's office and	131
approval of the executive director of the board. Before issuance	132
of a subpoena for patient record information, the executive	133
director shall determine whether there is probable cause to	134
believe that the complaint filed alleges a violation of this	135
chapter or any rule adopted under it and that the records sought	136
are relevant to the alleged violation and material to the	137
investigation. The subpoena may apply only to records that cover a	138
reasonable period of time surrounding the alleged violation.	139

(D) On failure to comply with any subpoena issued by the	140
board and after reasonable notice to the person being subpoenaed,	141
the board may move, pursuant to the Rules of Civil Procedure, for	142
an order compelling the production of persons or records.	143

(E) A subpoena issued by the board may be served by a	144
sheriff, the sheriff's deputy, or an investigator for the division	145
of emergency medical services of the department of public safety.	146
Service of a subpoena issued by the board may be made by	147
delivering a copy of the subpoena to the person named in it,	148
reading it to the person, or leaving it at the person's usual	149
place of residence. When the person being served is an individual	150
authorized by this chapter to practice emergency medical services,	151
service of the subpoena may be made by certified mail, restricted	152
delivery, return receipt requested, and the subpoena shall be	153
deemed served on the date delivery is made or on the date that the	154
person refuses to accept delivery.	155

Sec. 4765.102. (A) As used in this section, "licensing	156
agency" means any entity that has the authority pursuant to Title	157
XLVII of the Revised Code to issue a license, and any other agency	158
of this or another state, other than the Ohio supreme court, that	159
has the authority to issue a license that authorizes an individual	160
to engage in an occupation or profession. "Licensing agency"	161
includes an administrative officer that has authority to issue a	162
license that authorizes an individual to engage in an occupation	163
or profession.	164

(B) Except as provided in divisions (C) and (D) of this	165
section and section 4765.111 of the Revised Code, all information	166
the state board of emergency medical services receives pursuant to	167
an investigation, including information regarding an alleged	168
violation of this chapter or rules adopted under it or a complaint	169
submitted under division (A) of section 4765.101 of the Revised	170
Code, is confidential, and is not subject to discovery in any	171
civil action, during the course of the investigation and any	172
adjudication proceedings that result from the investigation. Upon	173
completion of the investigation and any resulting adjudication	174
proceedings, the information is a matter of public record for	175
purposes of section 149.43 of the Revised Code.	176

(C) The board may release information otherwise made	177
confidential by division (B) of this section to law enforcement	178
officers or licensing agencies of this or another state that are	179
prosecuting, adjudicating, or investigating the holder of a	180
certificate issued under this chapter or a person who allegedly	181
engaged in the unauthorized provision of emergency medical	182
services.	183

A law enforcement officer or licensing agency with	184
information disclosed by the board under this division shall not	185
divulge the information other than for the purpose of an	186
adjudication by a court or licensing agency to which the subject	187
of the adjudication is a party.	188

(D) If an investigation conducted under section 4765.101 of	189
the Revised Code requires a review of patient records, the	190
investigation and proceedings related to it shall be conducted in	191
such a manner as to protect patient confidentiality. The board	192
shall not make public the name or any other identifying	193
information about a patient unless proper consent is given in	194
accordance with rules adopted by the board. If the patient is less	195
than eighteen years of age, the board shall obtain consent from	196
the patient's parent, guardian, or custodian.	197

Sec. 4765.11.  (A) The state board of emergency medical	198
services shall adopt, and may amend and rescind, rules in	199
accordance with Chapter 119. of the Revised Code and division (C)	200
of this section that establish all of the following:	201

(1) Procedures for its governance and the control of its	202
actions and business affairs;	203

(2) Standards for the performance of emergency medical	204
services by first responders, emergency medical technicians-basic,	205
emergency medical technicians-intermediate, and emergency medical	206
technicians-paramedic;	207

(3) Application fees for certificates of accreditation,	208
certificates of approval, certificates to teach, and certificates	209
to practice, which shall be deposited into the trauma and	210
emergency medical services fund created in section 4513.263 of the	211
Revised Code;	212

(4) Criteria for determining when the application or renewal	213
fee for a certificate to practice may be waived because an	214
applicant cannot afford to pay the fee;	215

(5) Procedures for issuance and renewal of certificates of	216
accreditation, certificates of approval, certificates to teach,	217
and certificates to practice, including any procedures necessary	218
to ensure that adequate notice of renewal is provided in	219
accordance with division (D) of section 4765.30 of the Revised	220
Code;	221

(6) Procedures for suspending or revoking certificates of	222
accreditation, certificates of approval, certificates to teach,	223
and certificates to practice;	224

(7) Grounds for suspension or revocation of a certificate to	225
practice issued under section 4765.30 of the Revised Code and for	226
taking any other disciplinary action against a first responder,	227
EMT-basic, EMT-I, or paramedic;	228

(8) Procedures for taking disciplinary action against a first	229
responder, EMT-basic, EMT-I, or paramedic;	230

(9) Standards for certificates of accreditation and	231
certificates of approval;	232

(10) Qualifications for certificates to teach;

233

(11) Requirements for a certificate to practice;

234

(12) The curricula, number of hours of instruction and	235
training, and instructional materials to be used in adult and	236
pediatric emergency medical services training programs and adult	237
and pediatric emergency medical services continuing education	238
programs;	239

(13) Procedures for conducting courses in recognizing	240
symptoms of life-threatening allergic reactions and in calculating	241
proper dosage levels and administering injections of epinephrine	242
to adult and pediatric patients who suffer life-threatening	243
allergic reactions;	244

(14) Examinations for certificates to practice;

245

(15) Procedures for administering examinations for	246
certificates to practice;	247

(16) Procedures for approving examinations that demonstrate	248
competence to have a certificate to practice renewed without	249
completing an emergency medical services continuing education	250
program;	251

(17) Procedures for granting extensions and exemptions of	252
emergency medical services continuing education requirements;	253

(18) Procedures for approving the additional emergency	254
medical services first responders are authorized by division (C)	255
of section 4765.35 of the Revised Code to perform, EMTs-basic are	256
authorized by division (C) of section 4765.37 of the Revised Code	257
to perform, EMTs-I are authorized by division (B)(5) of section	258
4765.38 of the Revised Code to perform, and paramedics are	259
authorized by division (B)(6) of section 4765.39 of the Revised	260
Code to perform;	261

(19) Standards and procedures for implementing the	262
requirements of section 4765.06 of the Revised Code, including	263
designations of the persons who are required to report information	264
to the board and the types of information to be reported;	265

(20) Procedures for administering the emergency medical	266
services grant program established under section 4765.07 of the	267
Revised Code;	268

(21) Procedures consistent with Chapter 119. of the Revised	269
Code for appealing decisions of the board;	270

(22) Minimum qualifications and peer review and quality	271
improvement requirements for persons who provide medical direction	272
to emergency medical service personnel;	273

(23) The manner in which a patient, or a patient's parent,	274
guardian, or custodian may consent to the board releasing	275
identifying information about the patient under division (D) of	276
section 4765.102 of the Revised Code;	277

(24) Circumstances under which a training program or	278
continuing education program, or portion of either type of	279
program, may be taught by a person who does not hold a certificate	280
to teach issued under section 4765.23 of the Revised Code.	281

(B) The board may adopt, and may amend and rescind, rules in	282
accordance with Chapter 119. of the Revised Code and division (C)	283
of this section that establish the following:	284

(1) Specifications of information that may be collected under	285
the trauma system registry and incidence reporting system created	286
under section 4765.06 of the Revised Code;	287

(2) Standards and procedures for implementing any of the	288
recommendations made by any committees of the board or under	289
section 4765.57 of the Revised Code;	290

(3) Requirements that a person must meet to receive a	291
certificate to practice as a first responder pursuant to division	292
(A)(2) of section 4765.30 of the Revised Code;	293

(4) Any other rules necessary to implement this chapter.

294

(C) In developing and administering rules adopted under this	295
chapter, the state board of emergency medical services shall	296
consult with regional directors and regional physician advisory	297
boards created by section 4765.05 of the Revised Code and	298
emphasize the special needs of pediatric and geriatric patients.	299

(D) Except as otherwise provided in this division, before	300
adopting, amending, or rescinding any rule under this chapter, the	301
board shall submit the proposed rule to the director of public	302
safety for review. The director may review the proposed rule for	303
not more than sixty days after the date it is submitted. If,	304
within this sixty-day period, the director approves the proposed	305
rule or does not notify the board that the rule is disapproved,	306
the board may adopt, amend, or rescind the rule as proposed. If,	307
within this sixty-day period, the director notifies the board that	308
the proposed rule is disapproved, the board shall not adopt,	309
amend, or rescind the rule as proposed unless at least twelve	310
members of the board vote to adopt, amend, or rescind it.	311

This division does not apply to an emergency rule adopted in	312
accordance with section 119.03 of the Revised Code.	313

Sec. 4765.111. Except as provided in this section or sections	314
4765.112 to 4765.116 of the Revised Code, the state board of	315
emergency medical services shall conduct disciplinary proceedings	316
regarding the holder of a certificate issued under this chapter in	317
accordance with rules adopted by the board under section 4765.11	318
of the Revised Code.	319

The board and a holder of a certificate are the parties to a	320
hearing conducted under this chapter. Either party may submit a	321
written request to the other party for a list of witnesses and	322
copies of documents intended to be introduced at the hearing. The	323
request shall be in writing and shall be served not less than	324
thirty-seven days prior to the commencement of the hearing, unless	325
the hearing officer or presiding board member grants an extension	326
of time to make the request. Not later than thirty days before the	327
hearing, the responding party shall provide the requested list of	328
witnesses and copies of documents to the requesting party, unless	329
the hearing officer or presiding board member grants an extension	330
of time to provide the list and copies.	331

Failure to timely provide a list or copies requested in	332
accordance with this section shall result in exclusion from the	333
hearing of the witnesses, testimony, or documents.	334

Sec.  4765.112.  (A) The state board of emergency medical	335
services, by an affirmative vote of the majority of its members,	336
may suspend without a prior hearing a certificate to practice	337
issued under this chapter if the board determines that there is	338
clear and convincing evidence that continued practice by the	339
certificate holder presents a danger of immediate and serious harm	340
to the public and that the certificate holder has done any of the	341
following:	342

(1) Furnished false, fraudulent, or misleading information to	343
the board;	344

(2) Engaged in activities that exceed those permitted by the	345
individual's certificate;	346

(3) In a court of this or any other state or federal court	347
been convicted of, pleaded guilty to, or been the subject of a	348
judicial finding of guilt of, a judicial finding of guilt	349
resulting from a plea of no contest to, or a judicial finding of	350
eligibility for intervention in lieu of conviction for, a felony	351
or for a misdemeanor committed in the course of practice or	352
involving gross immorality or moral turpitude.	353

(B) Immediately following the decision to impose a summary	354
suspension, the board, in accordance with section 119.07 of the	355
Revised Code, shall issue a written order of suspension, cause it	356
to be delivered to the certificate holder, and notify the	357
certificate holder of the opportunity for a hearing. If timely	358
requested by the certificate holder, a hearing shall be conducted	359
in accordance with section 4765.115 of the Revised Code.	360

Sec.  4765.113.  If the state board of emergency medical	361
services imposes a suspension on the basis of a conviction,	362
judicial finding, or plea as described in division (A)(3) of	363
section 4765.112 of the Revised Code that is overturned on appeal,	364
the certificate holder, on exhaustion of the criminal appeal	365
process, may file with the board a petition for reconsideration of	366
the suspension along with appropriate court documents. On receipt	367
of the petition and documents, the board shall reinstate the	368
certificate holder's certificate to practice.	369

Sec. 4765.114.  (A) A certificate to practice emergency	370
medical services issued under this chapter is automatically	371
suspended on the certificate holder's conviction of, plea of	372
guilty to, or judicial finding of guilt of any of the following:	373
aggravated murder, murder, voluntary manslaughter, felonious	374
assault, kidnapping, rape, sexual battery, gross sexual	375
imposition, aggravated arson, aggravated burglary, aggravated	376
robbery, or a substantially equivalent offense committed in this	377
or another jurisdiction. Continued practice after the suspension	378
is practicing without a certificate.	379

(B) If the state board of emergency medical services has	380
knowledge that an automatic suspension has occurred, it shall	381
notify, in accordance with section 119.07 of the Revised Code, the	382
certificate holder of the suspension and of the opportunity for a	383
hearing. If timely requested by the certificate holder, a hearing	384
shall be conducted in accordance with section 4765.115 of the	385
Revised Code.	386

Sec. 4765.115.  (A) A suspension order issued under section	387
4765.112 or automatic suspension under section 4765.114 of the	388
Revised Code is not subject to suspension by a court prior to a	389
hearing under this section or during the pendency of any appeal	390
filed under section 119.12 of the Revised Code.	391

(B) A suspension order issued under section 4765.112 or	392
automatic suspension under section 4765.114 of the Revised Code	393
remains in effect, unless reversed by the state board of emergency	394
medical services, until a final adjudication order issued by the	395
board pursuant to this section becomes effective.	396

(C) Hearings requested pursuant to section 4765.112 or	397
4765.114 of the Revised Code shall be conducted under this section	398
in accordance with Chapter 119. of the Revised Code.	399

(D) A hearing under this section shall be held not later than	400
forty-five days but not earlier than forty days after the	401
certificate holder requests it, unless another date is agreed to	402
by the certificate holder and the board.	403

(E) After completion of an adjudication hearing, the board	404
may adopt, by an affirmative vote of the majority of its members,	405
a final adjudication order that imposes any of the following	406
sanctions:	407

(1) Suspension of the holder's certificate to practice;

408

(2) Revocation of the holder's certificate to practice;

409

(3) Issuance of a written reprimand;

410

(4) A refusal to renew or a limitation on the holder's	411
certificate to practice.	412

The board shall issue its final adjudication order not later	413
than forty-five days after completion of an adjudication hearing.	414
If the board does not issue a final order within that time period,	415
the suspension order is void, but any final adjudication order	416
subsequently issued is not affected.	417

(F) Any action taken by the board under this section	418
resulting in a suspension from practice shall be accompanied by a	419
written statement of the conditions under which the certificate to	420
practice may be reinstated. Reinstatement of a certificate	421
suspended under this section requires an affirmative vote by the	422
majority of the members of the board.	423

(G) When the board revokes or refuses to reinstate a	424
certificate to practice, the board may specify that its action is	425
permanent. An individual subject to permanent action taken by the	426
board is forever ineligible to hold a certificate of the type	427
revoked or refused, and the board shall not accept from the	428
individual an application for reinstatement of the certificate or	429
for a new certificate.	430

Sec. 4765.116.  If a certificate holder subject to a	431
suspension order issued by the state board of emergency medical	432
services under section 4765.112 or an automatic suspension order	433
under section 4765.114 of the Revised Code fails to make a timely	434
request for a hearing, the following apply:	435

(A) In the case of a certificate holder subject to a summary	436
suspension order, the board is not required to hold a hearing, but	437
may adopt, by an affirmative vote of a majority of its members, a	438
final order that contains the board's findings. In the final	439
order, the board may order any of the sanctions listed in division	440
(E) of section 4765.115 of the Revised Code.	441

(B) In the case of a certificate holder subject to an	442
automatic suspension order, the board may adopt, by an affirmative	443
vote of a majority of its members, a final order that permanently	444
revokes the holder's certificate to practice.	445

Sec. 4765.16.  (A) All courses offered through an emergency	446
medical services training program or an emergency medical services	447
continuing education program, other than ambulance driving, shall	448
be developed under the direction of a physician who specializes in	449
emergency medicine. Each course that deals with trauma care shall	450
be developed in consultation with a physician who specializes in	451
trauma surgery. EachExcept as specified by the state board of	452
emergency medical services pursuant to rules adopted under section	453
4765.11 of the Revised Code, each course offered through a	454
training program or continuing education program shall be taught	455
by a person who holds the appropriate certificate to teach issued	456
under section 4765.23 of the Revised Code.	457

(B) A training program for first responders shall meet the	458
standards established in rules adopted by the state board of	459
emergency medical services under section 4765.11 of the Revised	460
Code. The program shall include courses in both of the following	461
areas for at least the number of hours established by the board's	462
rules:	463

(1) Emergency victim care;

464

(2) Reading and interpreting a trauma victim's vital signs.

465

(C) A training program for emergency medical	466
technicians-basic shall meet the standards established in rules	467
adopted by the board under section 4765.11 of the Revised Code.	468
The program shall include courses in each of the following areas	469
for at least the number of hours established by the board's rules:	470

(1) Emergency victim care;

471

(2) Reading and interpreting a trauma victim's vital signs;

472

(3) Triage protocols for adult and pediatric trauma victims;

473

(4) In-hospital training;

474

(5) Clinical training;

475

(6) Training as an ambulance driver.

476

Each operator of a training program for emergency medical	477
technicians-basic shall allow any pupil in the twelfth grade in a	478
secondary school who is at least seventeen years old and who	479
otherwise meets the requirements for admission into such a	480
training program to be admitted to and complete the program and,	481
as part of the training, to ride in an ambulance with emergency	482
medical technicians-basic, emergency medical	483
technicians-intermediate, and emergency medical	484
technicians-paramedic. Each emergency medical service organization	485
shall allow pupils participating in training programs to ride in	486
an ambulance with emergency medical technicians-basic, advanced	487
emergency medical technicians-intermediate, and emergency medical	488
technicians-paramedic.	489

(D) A training program for emergency medical	490
technicians-intermediate shall meet the standards established in	491
rules adopted by the board under section 4765.11 of the Revised	492
Code. The program shall include, or require as a prerequisite, the	493
training specified in division (C) of this section and courses in	494
each of the following areas for at least the number of hours	495
established by the board's rules:	496

(1) Recognizing symptoms of life-threatening allergic	497
reactions and in calculating proper dosage levels and	498
administering injections of epinephrine to persons who suffer	499
life-threatening allergic reactions, conducted in accordance with	500
rules adopted by the board under section 4765.11 of the Revised	501
Code;	502

(2) Venous access procedures;

503

(3) Cardiac monitoring and electrical interventions to	504
support or correct the cardiac function.	505

(E) A training program for emergency medical	506
technicians-paramedic shall meet the standards established in	507
rules adopted by the board under section 4765.11 of the Revised	508
Code. The program shall include, or require as a prerequisite, the	509
training specified in divisions (C) and (D) of this section and	510
courses in each of the following areas for at least the number of	511
hours established by the board's rules:	512

(1) Medical terminology;

513

(2) Venous access procedures;

514

(3) Airway procedures;

515

(4) Patient assessment and triage;

516

(5) Acute cardiac care, including administration of	517
parenteral injections, electrical interventions, and other	518
emergency medical services;	519

(6) Emergency and trauma victim care beyond that required	520
under division (C) of this section;	521

(7) Clinical training beyond that required under division (C)	522
of this section.	523

(F) A continuing education program for first responders,	524
EMTs-basic, EMTs-I, or paramedics shall meet the standards	525
established in rules adopted by the board under section 4765.11 of	526
the Revised Code. A continuing education program shall include	527
instruction and training in subjects established by the board's	528
rules for at least the number of hours established by the board's	529
rules.	530

Sec. 4766.01.  As used in this chapter:

531

(A) "Advanced life support" means treatment described in	532
section 4765.39 of the Revised Code that a paramedic is certified	533
to perform.	534

(B) "Air medical service organization" means a person that	535
provides air medical transportation to the publican organization	536
that furnishes, conducts, maintains, advertises, promotes, or	537
otherwise engages in providing medical services with a rotorcraft	538
air ambulance or fixed wing air ambulance.	539

(C) "Air medical transportation" is the use of a rotorcraft	540
air ambulance or fixed wing air ambulance to provide	541
transportation and advanced life support to seriously ill,	542
injured, wounded, or otherwise incapacitated or helpless	543
individuals who require use of a stretcher from airport to airport	544
or from an emergency scene to a hospital or other medical care	545
settingmeans the transporting of a patient by rotorcraft air	546
ambulance or fixed wing air ambulance with appropriately licensed	547
and certified medical personnel.	548

(D) "Ambulance" means any motor vehicle that is specifically	549
designed, constructed, or modified and equipped and is intended to	550
be used to provide basic life support, intermediate life support,	551
advanced life support, or mobile intensive care unit services and	552
transportation upon the streets or highways of this state of	553
persons who are seriously ill, injured, wounded, or otherwise	554
incapacitated or helpless. "Ambulance" does not include air	555
medical transportation or a vehicle designed and used solely for	556
the transportation of nonstretcher-bound persons, whether	557
hospitalized or handicapped or whether ambulatory or confined to a	558
wheelchair.	559

(E) "Ambulette" means a motor vehicle that is specifically	560
designed, constructed, or modified and equipped and is intended to	561
be used for transportation upon the streets or highways of this	562
state of persons who require use of a wheelchair.	563

(F) "Basic life support" means treatment described in section	564
4765.37 of the Revised Code that an EMT-basic is certified to	565
perform.	566

(G) "Disaster situation" means any condition or situation	567
described by rule of the Ohio medical transportation board as a	568
mass casualty, major emergency, natural disaster, or national	569
emergency.	570

(H) "Emergency medical service organization" means an	571
organization that uses EMTs-basic, EMTs-I, or paramedics, or a	572
combination thereofof EMTs-basic, EMTs-I, and paramedics, to	573
provide medical care to victims of illness or injury. An emergency	574
medical service organization includes, but is not limited to, a	575
commercial ambulance service organization, a hospital, and a	576
funeral home.	577

(I) "EMT-basic," "EMT-I," and "paramedic" have the same	578
meanings as in section 4765.01 of the Revised Code.	579

(J) "Fixed wing air ambulance" means a fixed wing aircraft	580
operatedthat is specifically designed, constructed, or modified	581
and equipped and is intended to be used as a means of air medical	582
transportation.	583

(K) "Intermediate life support" means treatment described in	584
section 4765.38 of the Revised Code that an EMT-I is certified to	585
perform.	586

(L) "Major emergency" means any emergency event that cannot	587
be resolved through the use of locally available emergency	588
resources.	589

(M) "Mass casualty" means an emergency event that results in	590
ten or more persons being injured, incapacitated, made ill, or	591
killed.	592

(N) "Medical emergency" means an unforeseen event affecting	593
an individual in such a manner that a need for immediate care is	594
created.	595

(O) "Mobile intensive care unit" means an ambulance used only	596
for maintaining specialized or intensive care treatment and used	597
primarily for interhospital transports of patients whose	598
conditions require care beyond the scope of a paramedic as	599
provided in section 4765.39 of the Revised Code.	600

(P)(1) "Nonemergency medical service organization" means a	601
person that does both of the following:	602

(a) Provides services to the public on a regular basis for	603
the purpose of transporting individuals who require the use of a	604
wheelchair or are confined to a wheelchair to receive health care	605
services at health care facilities or health care practitioners'	606
offices in nonemergency circumstances;	607

(b) Provides the services for a fee, regardless of whether	608
the fee is paid by the person being transported, a third party	609
payer, as defined in section 3702.51 of the Revised Code, or any	610
other person or government entity.	611

(2) "Nonemergency medical service organization" does not	612
include a health care facility, as defined in section 1751.01 of	613
the Revised Code, that provides ambulette services only to	614
patients of that facility.	615

(P) "Mobile intensive care unit" means an ambulance used only	616
for maintaining specialized or intensive care treatment and used	617
primarily for interhospital transports of patients whose	618
conditions require care beyond the scope of a paramedic as	619
provided in section 4765.39 of the Revised Code.	620

(Q) "Nontransport vehicle" means a motor vehicle operated by	621
a licensed emergency medical service organization not as an	622
ambulance, but as a vehicle for providing services in conjunction	623
with the ambulances operated by the organization or other	624
emergency medical service organizations.	625

(R) "Patient" means any individual who as a result of illness	626
or injury needs medical attention, whose physical or mental	627
condition is such that there is imminent danger of loss of life or	628
significant health impairment, who may be otherwise incapacitated	629
or helpless as a result of a physical or mental condition, or	630
whose physical condition requires the use of a wheelchair.	631

(S) "Rotorcraft air ambulance" means a helicopter or other	632
aircraft capable of vertical takeoffs, vertical landings, and	633
hovering that is specifically designed, constructed, or modified	634
and equipped and is intended to be used as a means of air medical	635
transportation.	636

Sec. 4766.03.  (A) The Ohio medical transportation board	637
shall adopt rules, in accordance with Chapter 119. of the Revised	638
Code, implementing the requirements of this chapter. The rules	639
shall include provisions relating to the following:	640

(1) Requirements for an emergency medical service	641
organization to receive a permit for an ambulance or nontransport	642
vehicle;	643

(2) Requirements for an emergency medical service	644
organization to receive a license as a basic life-support,	645
intermediate life-support, advanced life-support, or mobile	646
intensive care unit organization;	647

(3) Requirements for a nonemergency medical service	648
organization to receive a permit for an ambulette vehicle;	649

(4) Requirements for a nonemergency medical service	650
organization to receive a license for an ambulette service;	651

(5) Requirements for an air medical service organization to	652
receive a permit for a rotorcraft air ambulance or fixed wing air	653
ambulance;	654

(6) Requirements for licensure of air medical service	655
organizations;	656

(7) Forms for applications and renewals of licenses and	657
permits;	658

(8) Requirements for record keeping of service responses made	659
by licensed emergency medical service organizations;	660

(9) Fee amounts for licenses and permits, and their renewals	661
thereof;	662

(10) Inspection requirements for licensees' vehicles or	663
aircraft, records, and physical facilities;	664

(11) Fee amounts for inspections of ambulances, ambulettes,	665
rotorcraft air ambulances, fixed wing air ambulances, and	666
nontransport vehicles;	667

(12) Requirements for ambulances and nontransport vehicles	668
used by licensed emergency medical service organizations, for	669
ambulette vehicles used by licensed nonemergency medical service	670
organizations, and for rotorcraft air ambulances or fixed wing air	671
ambulances used by licensed air medical service organizations that	672
specify for each type of vehicle or aircraft the types of	673
equipment that must be carried, the communication systems that	674
must be maintained, and the personnel who must staff the vehicle	675
or aircraft;	676

(13) The level of care each type of emergency medical service	677
organization, nonemergency medical service organization, and air	678
medical service organization is authorized to provide;	679

(14) Eligibility requirements for employment as an ambulette	680
driver, including grounds for disqualification due to the results	681
of a motor vehicle law violation check, chemical test, or criminal	682
records check. The rule may require that an applicant for	683
employment as an ambulette driver provide a set of fingerprints to	684
law enforcement authorities if the applicant comes under final	685
consideration for employment.	686

(15) Any other rules that the board determines necessary for	687
the implementation and enforcement of this chapter.	688

(B) In the rules for ambulances and nontransport vehicles	689
adopted under division (A)(12) of this section, the board may	690
establish requirements that vary according to whether the	691
emergency medical service organization using the vehicles is	692
licensed as a basic life-support, intermediate life-support,	693
advanced life-support, or mobile intensive care unit organization.	694

(C) A mobile intensive care unit that is not dually certified	695
to provide advanced life-support and meets the requirements of the	696
rules adopted under this section is not required to carry	697
immobilization equipment, including board splint kits, traction	698
splints, backboards, backboard straps, cervical immobilization	699
devices, cervical collars, stairchairsstair chairs, folding cots,	700
or other types of immobilization equipment determined by the board	701
to be unnecessary for mobile intensive care units.	702

A mobile intensive care unit is exempt from the emergency	703
medical technician staffing requirements of division (B) of	704
section 4765.43 of the Revised Code when it is staffed by at least	705
one physician or registered nurse and another person, designated	706
by a physician, who holds a valid license or certificate to	707
practice in a health care profession, and when at least one of the	708
persons staffing the mobile intensive care unit is a registered	709
nurse whose training meets or exceeds the training required for a	710
paramedic.	711

Sec. 4766.04.  (A) Except as otherwise provided in this	712
chapter, no person shall furnish, operate, conduct, maintain,	713
advertise, engage in, or propose or profess to engage in the	714
business or service in this state of transporting persons who are	715
seriously ill, injured, or otherwise incapacitated or who require	716
the use of a wheelchair or are confined to a wheelchair unless the	717
person is licensed pursuant to this section.	718

(B) To qualify for a license as a basic life-support,	719
intermediate life-support, advanced life-support, or mobile	720
intensive care unit organization, an emergency medical service	721
organization shall do all of the following:	722

(1) Apply for a permit for each ambulance and nontransport	723
vehicle owned or leased as provided in section 4766.07 of the	724
Revised Code;	725

(2) Meet all requirements established in rules adopted by the	726
Ohio medical transportation board regarding ambulances and	727
nontransport vehicles, including requirements pertaining to	728
equipment, communications systems, staffing, and level of care the	729
particular organization is permitted to render;	730

(3) Maintain the appropriate type and amount of insurance as	731
specified in section 4766.06 of the Revised Code;	732

(4) Meet all other requirements established under rules	733
adopted by the board for the particular license.	734

(C) To qualify for a license to provide ambulette service, a	735
nonemergency medical service organization shall do all of the	736
following:	737

(1) Apply for a permit for each ambulette owned or leased as	738
provided in section 4766.07 of the Revised Code;	739

(2) Meet all requirements established in rules adopted by the	740
Ohio medical transportation board regarding ambulettes, including	741
requirements pertaining to equipment, communication systems,	742
staffing, and level of care the organization is permitted to	743
render;	744

(3) Maintain the appropriate type and amount of insurance as	745
specified in section 4766.06 of the Revised Code;	746

(4) Meet all other requirements established under rules	747
adopted by the board for the license.	748

(D) To qualify for a license to provide air medical	749
transportation, an air medical service organization shall do all	750
of the following:	751

(1) Apply for a permit for each rotorcraft air ambulance and	752
fixed wing air ambulance owned or leased as provided in section	753
4766.07 of the Revised Code;	754

(2) Meet all requirements established in rules adopted by the	755
Ohio medical transportation board regarding rotorcraft air	756
ambulances and fixed wing air ambulances, including requirements	757
pertaining to equipment, communication systems, staffing, and	758
level of care the organization is permitted to render;	759

(3) Maintain the appropriate type and amount of insurance as	760
specified in section 4766.06 of the Revised Code;	761

(4) Meet all other requirements established under rules	762
adopted by the board for the license.	763

(E) An emergency medical service organization that applies	764
for a license as a basic life-support, intermediate life-support,	765
advanced life-support, or mobile intensive care unit organization;	766
a nonemergency medical service organization that applies for a	767
license to provide ambulette service; or an air medical service	768
organization that applies for a license to provide air medical	769
transportation shall submit a completed application to the board,	770
on a form provided by the board for each particular license,	771
together with the appropriate fees established under section	772
4766.05 of the Revised Code. The application form shall include	773
all of the following:	774

(1) The name and business address of the operator of the	775
organization for which licensure is sought;	776

(2) The name under which the applicant will operate the	777
organization;	778

(3) A list of the names and addresses of all officers and	779
directors of the organization;	780

(4) For emergency medical service organizations and	781
nonemergency medical service organizations, a description of each	782
vehicle to be used, including the make, model, year of	783
manufacture, mileage, vehicle identification number, and the color	784
scheme, insignia, name, monogram, or other distinguishing	785
characteristics to be used to designate the applicant's vehicle;	786

(5) For air medical service organizations using fixed wing	787
air ambulances, a description of each aircraft to be used,	788
including the make, model, year of manufacture, and aircraft Hobbs	789
meter hour reading;	790

(6) For air medical service organizations using rotorcraft	791
air ambulances, a description of each aircraft to be used,	792
including the make, model, year of manufacture, aircraft Hobbs	793
meter hour readinghours on airframe, aircraft identification	794
number, and the color scheme, insignia, name, monogram, or other	795
distinguishing characteristics to be used to designate the	796
applicant's rotorcraft air ambulance;	797

(7) The location and description of each place from which the	798
organization will operate;	799

(8) A description of the geographic area to be served by the	800
applicant;	801

(9) Any other information the board, by rule, determines	802
necessary.	803

(F) Within sixty days after receiving a completed application	804
for licensure as a basic life-support, intermediate life-support,	805
advanced life-support, or mobile intensive care unit organization;	806
an ambulette service; or an air medical service organization, the	807
board shall approve or deny the application. The board shall deny	808
an application if it determines that the applicant does not meet	809
the requirements of this chapter or any rules adopted under it.	810
The board shall send notice of the denial of an application by	811
certified mail to the applicant. The applicant may request a	812
hearing within ten days after receipt of the notice. If the board	813
receives a timely request, it shall hold a hearing in accordance	814
with Chapter 119. of the Revised Code.	815

(G) If an applicant or licensee operates or plans to operate	816
an organization in more than one location under the same or	817
different identities, the applicant or licensee shall apply for	818
and meet all requirements for licensure or renewal of a license,	819
other than payment of a license fee or renewal fee, for operating	820
the organization at each separate location. An applicant or	821
licensee that operates or plans to operate under the same	822
organization identity in separate locations shall pay only a	823
single license fee.	824

(H) An emergency medical service organization that wishes to	825
provide ambulette services to the public must apply for a separate	826
license under division (C) of this section.	827

(I) Each license issued under this section and each permit	828
issued under section 4766.07 of the Revised Code expires one year	829
after the date of issuance and may be renewed in accordance with	830
the standard renewal procedures of Chapter 4745. of the Revised	831
Code, except that a license or permit issued in 1998 or in 1999	832
prior to June 30, 1999, shall expire two years after the date of	833
issuance. An application for renewal shall include the license or	834
permit renewal fee established under section 4766.05 of the	835
Revised Code. An applicant for renewal of a permit also shall	836
submit to the board proof of an annual inspection of the vehicle	837
or aircraft for which permit renewal is sought. The board shall	838
renew a license if the applicant meets the requirements for	839
licensure and shall renew a permit if the applicant and vehicle or	840
aircraft meet the requirements to maintain a permit for that	841
vehicle or aircraft.	842

(J) Each licensee shall maintain accurate records of all	843
service responses conducted. The records shall be maintained on	844
forms prescribed by the board and shall contain information as	845
specified by rule by the board.	846

Sec. 4766.06.  (A)(1) Every emergency medical service	847
organization and nonemergency medical service organization	848
licensee under this chapter shall furnish adequate evidence of	849
liability insurance coverage, in an amount of not less than five	850
hundred thousand dollars per occurrence and not less than five	851
hundred thousand dollars in the aggregate, for any cause for which	852
the licensee would be liable.	853

(2) Every air medical service organization licenseelicensed	854
under this chapter shall furnish adequate evidence of liability	855
insurance coverage, in an amount not less than twenty million	856
dollars per occurrence and not less than twenty million dollars in	857
the aggregate, for any cause for which the licensee would be	858
liable.	859

(B) In addition to the insurance requirements of division (A)	860
of this section, every licensee shall carry bodily injury and	861
property damage insurance with solvent and responsible insurers	862
licensed to do business in this state for any loss or damage	863
resulting from any occurrence arising out of or caused by the	864
operation or use of any ambulance, ambulette, rotorcraft air	865
ambulance, fixed wing air ambulance, or nontransport vehicle. The	866
insurance shall insure each vehicle or aircraft for the sum of not	867
less than one hundred thousand dollars for bodily injury to or	868
death of any one person arising out of any one accident and the	869
sum of not less than three hundred thousand dollars for bodily	870
injury to or death of more than one person in any one accident and	871
for the sum of fifty thousand dollars for damage to property	872
arising from any one accident.	873

(C) Each policy or contract of insurance issued shall provide	874
for the payment and satisfaction of any financial judgment entered	875
against the licensee and any person operating the vehicle or	876
aircraft and for a thirty-day cancellation notice to the board.	877

Sec. 4766.07.  (A) EachExcept as otherwise provided by rule	878
of the Ohio medical transportation board, each emergency medical	879
service organization, nonemergency medical service organization,	880
and air medical service organization subject to licensure under	881
this chapter shall possess a valid permit for each ambulance,	882
ambulette, rotorcraft air ambulance, fixed wing air ambulance, and	883
nontransport vehicle it owns or leases that is or will be used by	884
the licensee to perform the services permitted by the license.	885
Each licensee and license applicant shall submit the appropriate	886
fee and an application for a permit for each ambulance, ambulette,	887
rotorcraft air ambulance, fixed wing air ambulance, and	888
nontransport vehicle to the Ohio medical transportation board on	889
forms provided by the board. The application shall include	890
documentation that the vehicle or aircraft meets the appropriate	891
standards set by the board, that the vehicle or aircraft has been	892
inspected pursuant to division (C) of this section, that the	893
permit applicant maintains insurance as provided in section	894
4766.06 of the Revised Code, and that the vehicle or aircraft and	895
permit applicant meet any other requirements established under	896
rules adopted by the board.	897

The Ohio medical transportation board may adopt rules in	898
accordance with Chapter 119. of the Revised Code to authorize the	899
temporary use of a vehicle or aircraft for which a permit is not	900
possessed under this section in back-up or disaster situations.	901

(B)(1) Within sixty days after receiving a completed	902
application for a permit, the board shall issue or deny the	903
permit. The board shall deny an application if it determines that	904
the permit applicant, vehicle, or aircraft does not meet the	905
requirements of this chapter and the rules adopted under it that	906
apply to permits for ambulances, ambulettes, rotorcraft air	907
ambulances, fixed wing air ambulances, and nontransport vehicles.	908
The board shall send notice of the denial of an application by	909
certified mail to the permit applicant. The permit applicant may	910
request a hearing within ten days after receipt of the notice. If	911
the board receives a timely request, it shall hold a hearing in	912
accordance with Chapter 119. of the Revised Code.	913

(2) If the board issues the vehicle permit for an ambulance,	914
ambulette, or nontransport vehicle, it also shall issue a decal,	915
in a form prescribed by rule, to be displayed on the rear window	916
of the vehicle. The board shall not issue a decal until all of the	917
requirements for licensure and permit issuance have been met.	918

(3) If the board issues the aircraft permit for a rotorcraft	919
air ambulance or fixed wing air ambulance, it also shall issue a	920
decal, in a form prescribed by rule, to be displayed on the left	921
fuselage aircraft window in a manner that complies with all	922
applicable federal aviation regulations. The board shall not issue	923
a decal until all of the requirements for licensure and permit	924
issuance have been met.	925

(C) In addition to any other requirements that the board	926
establishes by rule, a licensee or license applicant applying for	927
an initial vehicle or aircraft permit under division (A) of this	928
section shall submit to the board the vehicle or aircraft for	929
which the permit is sought. Thereafter, a licensee shall annually	930
submit to the board each vehicle or aircraft for which a permit	931
has been issued.	932

(1) The board shall conduct a physical inspection of an	933
ambulance, ambulette, or nontransport vehicle to determine its	934
roadworthiness and compliance with standard motor vehicle	935
requirements.	936

(2) The board shall conduct a physical inspection of the	937
medical equipment, communication system, and interior of an	938
ambulance to determine the operational condition and safety of the	939
equipment and the ambulance's interior and to determine whether	940
the ambulance is in compliance with the federal requirements for	941
ambulance construction that were in effect at the time the	942
ambulance was manufactured, as specified by the general services	943
administration in the various versions of its publication titled	944
"federal specification for the star-of-life ambulance,	945
KKK-A-1822."	946

(3) The board shall conduct a physical inspection of the	947
equipment, communication system, and interior of an ambulette to	948
determine the operational condition and safety of the equipment	949
and the ambulette's interior and to determine whether the	950
ambulette is in compliance with state requirements for ambulette	951
construction. The board shall determine by rule requirements for	952
the equipment, communication system, interior, and construction of	953
an ambulette.	954

(4) The board shall conduct a physical inspection of the	955
medical equipment, communication system, and interior of a	956
rotorcraft air ambulance or fixed wing air ambulance to determine	957
the operational condition and safety of the equipment and the	958
aircraft's interior.	959

(5) The board shall issue a certificate to the applicant for	960
each vehicle or aircraft that passes the inspection and may assess	961
a fee for each inspection, as established by the board.	962

(6) The board shall adopt rules regarding the implementation	963
and coordination of inspections. The rules may permit the board to	964
contract with a third party to conduct the inspections required of	965
the board under this section.	966

Sec. 4766.17. (A) An air medical service organization	967
licensed under this chapter that uses a rotorcraft or fixed wing	968
air ambulance shall do both of the following:	969

(1)(A) Use at a minimum both of the following to provide	970
advanced life support to seriously ill, injured, wounded, or	971
otherwise incapacitated or helpless individuals who require use of	972
a stretcher:	973

(a) A paramedica physician who holds a current valid license	974
issued under Chapter 4731. of the Revised Code or registered nurse	975
who holds a current valid license issued under Chapter 4723. of	976
the Revised Code, both as defined in section 4765.01 of the	977
Revised Code;	978

(b) Onea paramedic, or one other person, designated by the	979
medical director of the air medical service organization, who	980
holds a current, valid certificate or license to practice a health	981
care profession in this state.;	982

(2)(B) Employ as a medical director an individual who holds a	983
current, valid certificate issued under Chapter 4731. of the	984
Revised Code authorizing the practice of medicine and surgery or	985
osteopathic medicine and surgery.	986

(B) The medical director employed by a licensed air medical	987
service organization pursuant to division (A)(2) of this section	988
is ultimately responsible for the medical care provided to each	989
patient by the organization.	990

Section 2. That existing sections 513.10, 749.18, 4765.05,	991
4765.11, 4765.16, 4766.01, 4766.03, 4766.04, 4766.06, 4766.07, and	992
4766.17 of the Revised Code are hereby repealed.	993