TO: MEMBERS OF THE SENATE

HEALTH COMMITTEE

DATE: March 2, 2001

SUBJECT: Strike Everything Amendment to S.B. 1319 (emergency ward; hospital diversion)

Purpose

Allows the medical director of an emergency medical service (EMS) provider or an ambulance service to establish protocols to refer, advise or transport patients from an emergency response to the most appropriate health care institution.

Background

Currently, hospital emergency departments around the country are experiencing overcrowding and internal resource limitations. Staff shortages, facility closures, inappropriate emergency department use and increased use of emergency department facilities all place a strain on hospital emergency departments. At times, overcrowding and resource limitations have resulted in hospital emergency departments refusing to take patients until a bed is available. When a hospital emergency department is under diversion, ambulances must take patients to another facility or wait until a bed becomes available, depending upon the seriousness of the illness or injury.

According to the Arizona College of Emergency Physicians, two Maricopa County hospitals were on diversion 25 percent of the time last winter and one Tucson hospital is now on diversion 50 percent of the time. Arizona Administrative Code allows a medical staff committee at a hospital to exceed the hospital’s licensed capacity in emergency situations (A.A.C. R9-10-213). Hospitals, which exceed licensed capacity in emergency situations, are required to suspend elective admissions until the hospital is below the licensed capacity.

Current statute requires the Director of the Department of Health Services (DHS) to establish protocols allowing an EMS provider to refer, advise or transport patients by the most appropriate means to the most appropriate medical services provider based on the patients condition. However, rules have not yet been formally adopted. The strike everything amendment to S.B. 1319 allows the medical director of an EMS provider or ambulance service to develop protocols for emergency medical technicians (EMT) to refer, advise or transport patients to the most appropriate health care institution based upon the patient’s condition, unless the condition poses an immediate threat to life or limb. Additionally, the amendment requires EMTs to consider patient choice, a patient’s health care provider, specialized health care facilities and local protocols.

There is no cost to the state general fund associated with the provisions of this measure.

Provisions

1. Allows, pending protocols adopted by DHS, the medical director of an EMS provider or ambulance service to establish triage and treatment protocols for EMTs who respond to emergency calls that do not pose a threat to life or limb.

2. Stipulates the protocols are for referring, advising or transporting patients to the most appropriate health care institution based on the patient’s condition and providing a list of alternative sites available to deliver care.

3. Exempts DHS from the rulemaking process for rules established or revised pursuant to this act.

4. Provides for a general effective date.

KS/jas