11.25.14 Paramedic Recommendation

Town of Canton
Fire & EMS

Upgrade to Paramedic Level Service
Board of Selectmen
Information Packet
November 18, 2014
Town of Canton
4 Market Street, Collinsville, Connecticut 06022
Fire and EM S Departm ent

EMS Division
Collinsville Station
Office :(860) 693-2325 Fax: (860) 693-2371
Board of Selectmen
Town of Canton
Post Office Box 168
4 Market Street
Collinsville, Connecticut 06022
November 3, 2014
RE: Emergency Medical Services Upgrade to Paramedic

Dear Selectmen,
Thank you for considering the proposed changes to the level of emergency medical services
provided to the Town of Canton.
The Town of Canton has been fortunate to have been served by combination of volunteers
and paid staffing for many years. However as the population and demographics of the
Town have changed so too have changes in training requirements for certifications and recertifications. In recent years new emergency medical interventions and equipment have
been developed. These changes present new challenges for providing the highest level of
quality patient care.
Many towns have struggled with the same issues of upgrading to paramedic level service
and invariably the debate comes down to one issue, cost. Its simple to say that if there
were no consideration for costs, every town would want the highest level of care available.
This proposal seeks to find a balance between cost and patient care.
In Canton, we are facing both a financial question and the issue of continuing sponsorship
of our current AEMT level of service. The University of Connecticut Medical Center is our
sponsor hospital and effective July 1, 2016 they will no longer sponsor our AEMT level of
service.
This change in sponsorship reflects changes that have been on the agenda at State levels of
government as well. The University of Connecticut has been an outstanding partner in our
Towns emergency medical services but just as Canton needs to change they do too.
In this presentation packet our department provides the Board of Selectmen with viable
options for moving emergency medical services in a positive direction. The preferred
upgrade in service is to full-time commercially staffed paramedics with a fly-car utilizing

the current combination of volunteer and commercial EMTs . It provides the highest level
of emergency medical coverage with the greatest flexibility and potential for
reimbursement income. Other approaches described in the packet allow for a scalable
method of achieving paramedic coverage though they come with certain limitations.
Our department is prepared to work with the Town staff to implement the most beneficial
level of emergency service as selected by your committee.
We appreciate your time and efforts and invite your questions so that we may help you
make an informed decision.
Respectfully,
________________________________________
Richard Hutchings MPA, RN EMT-P,
Chief Town of Canton Fire & EMS
________________________________________
John Bunnell, EMT-P, BA
Assistant Chief Town of Canton Fire & EMS
John Bunnell BA, NREMT-P

Assistant Chief
Town of Canton Fire & EMS Department
4 Market Street
P.O. Box 168
Canton, CT 06019
Dear Chief
As the EMS Coordinator at John Dempsey Hospital, I am in support of Canton Ambulance
upgrading to the paramedic level of service.
I believe the paramedic level of service will help provide the best and timeliest care to the
citizens of Canton.
I look forward to continuing to work with Canton Ambulance on issues of education, medical
oversight and quality improvement.
You have are provided excellent service over the years. Upgrading to the paramedic level will
continue and enhance this service.
Best,
Peter
Peter Canning
EMS Coordinator
John Dempsey Hospital
canning@uchc.edu
(860) 679-3485
Town of Canton
Fire & EMS
Contents
Town of Canton Fire & EMS

Canton, Connecticut
Contents
Cover Letters
Overview
Section 1
Options for Emergency Service Levels
Section 2
Start-Up Costs
Medications & Supplies
Medical Equipment
Paramedic Vehicle
Section 3
Financials
Section 4
Summary
o Operating Cost Models
o Reimbursement Rates/Call/Run Data
Tabular Comparison of Levels of Service
Section 5
Timeline/Schedule
Section 6
Scalability and Exit Strategy
Section 7
EMS Study Committee Report dated September 7, 2012
Section 8
Reference Materials
Section 9
BOS EMS Subcommittee Report dated 2-25-13
General Assembly Bill 416 Raised in February 2014 Session
Jewel Mullen, MD DPH Memo to Office of Policy Management November 1, 2013

Department of Public Health Connecticut Emergency Medical Services Primary Service
Area Task Force Final Report dated February 7, 2014
Dr. Kamin & Mr. Canning Curriculum Vitae
Town of Canton
Fire & EMS
Overview
Section 1

Canton, Connecticut
Overview
Brief History:
The Canton Memorial Ambulance was formed in 1950 by employees of the Collins Company.
The Canton Memorial Ambulance was established as living memorial to U.S. war veterans. The
ambulance operated as an independent organization from 1950 till 1963 when it merged with the
Collins Company Fire Department.
In 1987 Chief Hutchings spearheaded an effort to upgrade to service to the present AEMT Level
(formerly known as the Intermediate Level) of service. The AEMT Level of service essentially
provides three key skills, enhanced assessment, IV therapy to improve blood volume/pressure
and better airway management over the basic skills (though not to the gold standard of intubation
as provided by paramedics). In the last few years the service has added new protocols and
equipment to improve patient care (QuikClot, Lucas 2, Naloxone, CPAP). While these have all
been good improvements they fall short of the level of service provided by paramedics.
Our sponsor hospital is the University of Connecticut Health Center in Farmington. Notice has
been given that effective July 1, 2016 they (UConn) will no longer sponsor Canton at the AEMT
level. Canton is the last remaining AEMT level service operating in the region. (Please see area
map at the end of this Overview)
Additional Background Regarding Canton EMS:
In the third quarter of 2011 the Board of Selectmen appointed a Temporary Committee to make
recommendations for long range plans for providing Emergency Medical Services (EMS) for the
Town of Canton.
The Committee submitted a report to the Board of Selectmen dated September 7, 2012. The
report recommended upgraded to paramedic level of service within two years. The report is
included for reference in Section 8.
The Town of Canton Volunteer Fire and EMS is part of Region 3 of the Connecticut Regional
EMS Councils and as such is governed by the North Central CT EMS Council Regional
Guidelines. To better understand the various levels of service (EMR, EMT, AEMT, Paramedic)
in detail a copy of the Guidelines have been provided. As this is a 220 page document only a
single copy has been made a part of this submission. Additional copies are available on request
or may be viewed on line at:
http://www.ctemscouncils.org/downloads/NC_EMS_%20Guidelines.pdf
Current Status:
At present when a 911 call is received a Canton Police Officer is dispatched to the scene. That
responding officer is our Towns First Responder. Car 10 is dispatched, provided a full legal
crew is available, to the scene and assumes responsibility for the patient(s). If a higher level of
care is required paramedics are dispatched from UConn. Depending on the nature of the call
they either meet on scene or intercept during transport.
In the State of Connecticut there are four levels of Primary Service Area Responder levels:
First Responder
Basic Ambulance
Intermediate Ambulance
Paramedic
As currently certified by the Connecticut Department of Health our primary ambulance (Car 10)
must be staffed to provide the intermediate level service (AEMT + EMT) in order to respond to a
call. The second ambulance (Car 11) must provide basic level of service (1 EMT + 1 EMT) at a
minimum. The second car out may provide intermediate level service as long as an AEMT is on
board.
The service is staffed by a paid service provider 06:00 to 18:00 Monday through Friday with a
crew of an AEMT and an EMT.
From 18:00 to 06:00 every day and 06:00 to 18:00 on weekends a volunteer crew staffs the
ambulance.
If a full legal crew (AEMT + EMT) is not available, even if two EMTs are ready at the station
to respond, the dispatcher must request mutual aid from a surrounding town in order to satisfy
the requirements established for an AEMT level service.
Time:
At present UConn provides paramedic services to the Town of Canton. As noted in the EMS
Study Committee Report, the average response times for paramedics was 16.95 minutes with
90% of all calls arriving within 32 minutes. Ten percent of the response times for medics was
between 32 and 68 minutes. The NFPA 1710 standard is an 8 minute response time. At best
UConn is 13 minutes from Canton. Traffic and weather have a significant impact on response
times. Establishing a paramedic service in Town will mitigate the majority of risk of travel
distance.
Sample Scenario:
If the Town upgrades to paramedic level service Car 10 will be able to
respond to all calls with a Basic ambulance (R2) and the paramedic
will be able to respond via a separate fly car. If after evaluation the
patient may be transported at the BLS level, the paramedic will remain
in Town prepared for the next call. Assuming a second call is
activated while the first ambulance is out of Town, the medic and a
second basic level ambulance can respond. Taking it one step further,
a third call is activated while both ambulances are out of Town, the
medic can respond and a mutual aid call for a basic ambulance can go
out to our partner towns.
It is not that uncommon to have both Car 10 and Car 11 activated at
one time. In fact, we have had the rare occasion of multiple medical
calls that were responded to by Car 10, Car 11, Utility 8, Rescue 9 plus
personal owned vehicles (POVs).
By establishing a paramedic service in Town a higher level of care and maximization of current
resources can be developed.
What does Paramedic-level Service Mean?
Please see Section 5 for a Matrix Comparing EMR, EMT-Basic, AEMT and Paramedic Levels of
Service.
Timeline:
Please see attached Gantt chart for transitioning to paramedic level service.
High-level View of Next Steps:
Over the course of the next several months steps will need to be taken to either downgrade our
service to the Basic EMT level or implement a plan to provide the paramedic level of service in
Canton. Depending on meeting schedules, planning for Town vote (if required), verifying costs,
filing appropriate documents with the State the overall process may take 12 to 18 months. A
preliminary implementation timeline/schedule has been included in Section 6 of this information
packet.
Review and approval by Town of Canton Board of Selectmen

Review and approval by Town of Canton Board of Finance
Depending on direction of the BOS:
o Town RFP for Paramedic Staffing
o Town RFP for Outsourced Paramedic Service
o Town Referendum to approve change in service
Goals:
Provide the highest level or patient care in the Town of Canton
Procure the appropriate level and quality of medical equipment and/or support vehicle
Procure commercial qualified paramedic staffing company services
Maintain the current core of qualified EMTs and FF/EMTs
Further develop the management of the Canton EMS
Enhance cooperation with surrounding towns
Work towards self-sufficiency through run volume, collection ratio and rate structure
HARTLAND
CANTON
BRISTOL
BURLINGTON
Hartford
County
Text
Towns with Paramedic Service
GRANBY
SIMSBURY
AVON
AM
R
FARMINGTON
AM
R
PLAINVILLE
AM
R
SOUTHINGTON
AM
R
EAST
GRANBY
EAST
HARTFORD
WINDSOR
LOCKS
ROCKY
HILL
Aetn
a
Aetn
a
WETHERSFIELD
Aetna
/
AMR
HARTFORD
WINDSOR
SUFFIELD
BLOOMFIELD
AM
R
NEWINGTON
AM
R
WEST
HARTFORD
NEW
BRITAIN
BERLIN
ENFIELD
EAST
WINDSOR
SOUTH
WINDSOR
MANCHESTER
GLASTONBURY
MARLBOROUGH
Town of Canton
Fire & EMS
Options for
Emergency
Medical Services
Section 2

Canton, Connecticut
Options
for
Emergency Medical Service Levels
Recommended Options:
Outsource for Paramedic Staffing (eliminate AEMT)
Outsource for Paramedic Staffing (maintain two EMTs add fly car)
Outsource for Paramedic Staffing (maintain one EMT 06:00 to 18:00 and add fly
car for nights and weekends)
Not Recommended Options:
Downgrade to BLS/Continue Paramedic Service from UConn Medical Center
Create Town of Canton Paramedic Employee positions
Completely Out-source Paramedic Level Service (Aetna, AMR, Campion, Hunters,

other)
Downgrade to Basic Life Support

Continue Paramedic Service from UConn Medical Center
This model changes the current staffing level requirements from a minimum of one AEMT plus
one EMT to two EMTs.
The primary effects of this change versus the current status are:
Pros:
Reduction in out-sourced staffing costs
Ability for volunteers to respond with the primary ambulance (Car 10) without need for
AEMT requirement.
Cons:
Reduced level of emergency medical assessment
Does not improve response times of paramedic dispatched from UConn to Canton
Reduces reimbursement rates (income) for calls responded to with the lower level of
service
Create Town of Canton Paramedic Employee Positions

Creating permanent paramedic positions to be staffed by individuals hired directly by the Town
of Canton.
Pros:
Improves the response times of paramedics to provide highest level of emergency
medical care in the field and during transport.
Increased level of emergency medical assessment and care
Increases reimbursement rates (income) for calls responded to with the higher level of
service
Cons:
Increases immediate labor costs and long term commitments for benefits
Requires holiday pay in excess of that provided by out-sourced services
Places burden of managing and paying for training on Town of Canton
Completely Out-source Paramedic Level Service
Utilize a commercial emergency medical service company (Aetna, AMR, Campion, Hunters,
other) to provide all emergency medical services to the Town.
Pros:
Places burden of paying for training on the out-sourced company
Avoids long term employment benefit obligations for the Town
Eliminates the need to provide ambulance apparatus, medical supplies and training
Cons:
Town call volume may not attract multiple bidders for the scope of services requested in
an RFP
Eliminates any reimbursement income for calls
Shifts burden of some first aid consumables on Police and Fire (O2, masks, basic
supplies)
Likely eliminates volunteer Canton Memorial Ambulance
Outsource for Paramedic Staffing (eliminate AEMT)

Utilize a commercial emergency medical staffing service (Aetna, AMR, Campion, Hunters,
Vintech, other) to provide an emergency medical paramedic to staff the existing ambulance
provided by the Town. This option would replace the AEMT that is currently paid for by the
Town (M-F/06:00 to 18:00) and add a paramedic for the remaining shifts. By having a medic on
the schedule for all shifts the Town will avoid costs for outsourced AEMTs that have been hired
with greater frequency due to a lack of available volunteer AEMTs.
Pros:
service
Maintains Canton Memorial Ambulance participation and the provides the Town with
reimbursement income provided by volunteer efforts
Potential for reimbursement for paramedic service provided to mutual aid towns
Cons:
Commits paramedic to Car 10 only
an RFP
Added cost of providing medical equipment and medications to start up service
Outsource Paramedic Staffing (maintain two EMTs add fly car)

provided by the Town. This option would change the current EMT/AEMT team to two EMTs
paid for by the Town (M-F/06:00 to 18:00) and add a paramedic for all shifts.
By having a medic on the schedule for all shifts the Town will avoid costs for outsourced
AEMTs that have been hired with greater frequency due to a lack of available volunteer
AEMTs. Further the paramedic in a fly car offers the ultimate in volunteer utilization,
flexibility for apparatus responding and maximized reimbursement rates.
Pros:
service
Cons:
an RFP
Added cost of providing fly car to begin service
Outsource for Paramedic Staffing (maintain one EMT 06:00 to 18:00 and add fly car for
nights and weekends)
provided by the Town. This hybrid option would change the current EMT/AEMT team to one
EMT paid for by the Town (M-F/06:00 to 18:00) and add a paramedic for all shifts.
By having a medic on the schedule for all shifts the Town will avoid costs for outsourced
AEMTs that have been hired with greater frequency due to a lack of available volunteer
AEMTs. Further the paramedic in a fly car offers the ultimate in volunteer utilization,
flexibility for apparatus responding and maximized reimbursement rates.
Pros:
service
Scalability, if call volume warrants, a second EMT can be added and the medic utilizes
the fly car.
Cons:
Added cost of providing fly car to begin service
Town of Canton
Fire & EMS
Start-up Costs
Section 3
- Acetaminophen (Tylenol)
- Adenosine 12mg, 4 ml vial
- Adenosine 6mg, 2 ml vial
- Albuterol
- Amiodarone
- Aspirin
- Atropine
- Benzocaine Spray
- Calcium Chloride
- Dextrose (D10)
- Dextrose (D50)
- Diltiazem
- Diphenhydramine
- Dopamine
- Epinephrine (1:1000)
- Epinephrine (1:10,000)
- Glucagon
- Haloperidol
- Ipratropium Bromide
- Lactated Ringers
- Lidocaine
- Magnesium Sulfate
- Metoclopramide Hydrochloride (Reglan)
MedicationCosts
UpgradetoParamedicLevelService
0
2
2
8
1
0
2
0
4
36
1
1
1
3
1
3
2
1
6
1
1
1
4
Qty.
Town of Canton Volunteer Fire and EMS
each
each
bx/10
bx/10
pk/25
each
bx/25
cs/50
each
bx/10
bx/30
cs/24
bx/10
bx/10
each
bx/10
bx/10
bx/10
bx/25
pk/25
Unit
0.00
199.90
62.90
11.79
124.75
0.00
152.99
0.00
15.79
3.79
161.99
68.20
73.50
24.29
81.25
98.99
267.99
84.60
62.70
100.56
87.99
96.75
2.22
Unit
Cost
0.00
399.80
125.80
94.32
124.75
0.00
305.98
0.00
63.16
136.44
161.99
68.20
73.50
72.87
81.25
296.97
535.98
84.60
376.20
100.56
87.99
96.75
8.88
Totals
Sub Total
1
2
0
4
0
0
1
3
2
2
3
2
1
3
cs/100
bx/25
each
bx/10
each
each
pk/25
each
bx/25
bx/25
bx/10
224.75
56.80
0.00
21.29
0.00
0.00
228.00
58.99
2.73
112.99
17.09
41.59
166.50
70.69
UCONN will exchange our Narc kits, they provide this service at no cost the narc kits contain:
- Fentanyl Citrate
- Midazolam
- Morphine Sulfate
- Solu-Medrol
- Metoprolol
- Naloxone
- Nitrostat
- Normal Saline
- Olanzipine ( Zyprexa)
- Odansetron
- Procainamide
- Racemic Epinephrine
- Sodium Bicarbonate
- Tetracaine
- topex
- Vasopressin
- Zyprexa
224.75
113.60
0.00
85.16
0.00
0.00
228.00
176.97
5.46
225.98
51.27
83.18
166.50
212.07
4868.93
SubTotal
- Laryngoscope Blades (Mac 1-4, Miller 0-4)

- Endotracheal Tubes (2-5 uncuffed)
- Endotracheal Tubes (5-9 cuffed)
- King Airway Kits Pedi
- King Airway Kits Adult
- Meconium aspirator
- Adult Magill forceps
- Pedi Magill forceps
- Nasal ETCO2
- Endotracheal Tube ETCO2
- Smart Capnoline Pedi
- Smart Capnoline Adult
- Endotracheal Tube introducer (Bougie)
ConsumableEquipment
- Lifepak 15 Cardiac Monitor/Defibrillator

- Laryngoscope Handle (Adult/Pedi)
DurableEquipment
EquipmentCosts
Unit
cs/20
bx/10
bx/10
cs/5
cs/5
each
each
each
bx/25
bx/100
bx/10
1
1
5
each
each
Unit
QTY
11
8
11
2
4
3
2
2
1
4
QTY
35,000.00
319.96
35,319.96
Cost
107.80 1,185.80
25.00 200.00
24.00 264.00
186.95 373.90
175.95 703.80
6.36 19.08
6.49 12.98
6.49 12.98

367.25 367.25
1,219.00 1,219.00
104.90 524.50
35000
79.99
Cost
Initial
Cost
TotalEquipmentCosts
SubTotal
- Intraosseous Drill
- Intraosseous Needles (Adult)
- Intraosseous Needles (pedi)
- Intraosseous Needles (bariatric)
- 1 ml syringes
- 5 ml syringes
- 10 ml syringes
- Safety Glide Syringe with Needle 1cc
- Hypodermic needles
- Electrodes (Adult, pedi)
- ECG paper
- Morgan Lens
- Nebulizer assemblies
- Nebulizer mask (adult, pedi)
- Twinpak Dual Cannula device
- Chest decompression needles (Adult,Pedi)
- Cricothyrotomy Kit
1
10
3
5
1
1
1
1
1
1
1
1
2
3
3
2
2
1
5
2
each
each
each
each
bx/100
bx/125
bx/100
cs/400
cs/400
cs/400
cs/400
bx/100
cs/1000
cs/18
each
cs/50
cs/50
bx/100
each
each
700.00
120.00
120.00
120.00
59.89
24.39
25.59
261.52
243.92
287.92
295.92
36.89
315.80
95.22
30.89
51.00
75.00
68.00
13.99
219.98
45,699.17
700.00
1,200.00
360.00
600.00
59.89
24.39
25.59
261.52
243.92
287.92
295.92
36.89
631.60
285.66
92.67
102.00
150.00
68.00
69.95
439.96
10,379.21
Ford Explorer or Chevy Tahoe

Graphics package
Lighting package
Knox Box
Narcotics Lockbox
1 VHF 2 UHF mobiles, 1 VHF portable
Sub Total
Fly-Car Vehicle
33,000
3,000
7,000
1,500
1,000
4,000
49,500
Town of Canton
Fire & EMS
Financials
Section 4

OptionsSummary
11/17/2014
Year1
RecommendedOptions
Onemedic+oneEMT(noflycar)
Projections*
($297,047)
Onemedic+twoEMT'sw/Flycar
($387,837)
Onemedic+oneEMTw/Flycar(offhoursonly)
($341,737)
NotRecommended
DowngradetoBLS
($130,627)
OutsourceallEMStocommercialservice
(sometownspayinexcessof
$400,000duetolowcallvolume,
otherspayverylittle.)
$382,000
to
$20,000
Townemployeeparamedics
($580,487)
BasisofProjections:
FY11143YearAverages(rounded)
3YearAverageExpense
3YearAverageRevenue
3YearAverageAnnualShortfall
$424,000
$334,000
$(90,000)
*Projectionsarebasedoncurrentspendingandrevenues.Thatis,projectednumbersinclude
anticipatedoperatinglossesaspreviouslyexperienced.
**DoesnotincludethevalueofliquidatingcurrentEMSequipmentandapparatus.
**
**
11/16/2014
1FTMedic/1EMTFlyCar
FY's11 14
3Year
Average
EmergencyServicesFund
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
EmergencyServicesFund*
OperatingGain/(Loss)
revenue
334,303
(89,827)
Adjustments:
ALSinlieuofBLSclassifications
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
AddParamedic(commercial24/7@$31/hr)
Reduce1EMT(618MF)
ReducedAEMTstaffingtocovervolunteershifts
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
50
25
31
0
8760
3120
CostIncreases
orReduced
Revenues
$ 35,400
$ 17,800
$ 17,050
$271,560
$
$ 30,000
Medications
Equipment
Vehicle
$ 14,000
$ 45,700
$ 49,500
Fuel
Maintenance/Tires
$ 4,000
$ 3,500
Equipment/ExpenseContingency
SubTotalIncreasesandReductions
TotalProjectedFirstYearCost
$10,000.0
$100,250.0 $398,260.0 $(298,010.0)
$(387,836.7)
11/16/2014
1FTMedic/1EMTFlyCar(OffHoursOnly)
FY's11 14
3Year
Average
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
revenue
334,303
(89,827)
Adjustments:
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
Reduce1EMT(618MF)
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
25
5
31
22
8760
3120
CostIncreases
orReduced
Revenues
$ 35,400
$ 8,900
$ 3,410
$271,560
$ 68,640
$ 30,000
Medications
Equipment
Vehicle
$ 14,000
$ 45,700
$ 49,500
Fuel
Maintenance/Tires
$ 4,000
$ 3,500
$10,000.0
$146,350.0 $398,260.0 $(251,910.0)
$(341,736.7)
11/16/2014
1FTMedic/1EMTNoFlyCar
FY's11 14
3Year
Average
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
revenue
334,303
(89,827)
Adjustments:
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
Reduce1EMT(618MF)
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
0
0
31
22
8760
3120
CostIncreases
orReduced
Revenues
$ 35,400
$
$
$271,560
$ 68,640
$ 30,000
Medications
Equipment
Vehicle
$ 14,000
$ 45,700
$
Fuel
Maintenance/Tires
$
$
$10,000.0
$134,040.0 $341,260.0 $(207,220.0)
$(297,046.7)
11/16/2014
DowngradetoBLS
FY's11 14
3Year
Average
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
revenue
334,303
(89,827)
Adjustments:
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
Reduce1EMT(618MF)
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
200
0
0
31
22
0
0
CostIncreases
orReduced
Revenues
$70,800
$
$
$
$
$30,000
Medications
Equipment
Vehicle
$
$
$
Fuel
Maintenance/Tires
$
$
$
$30,000.0 $70,800.0 $(40,800.0)
$(130,626.7)
11/16/2014
1FTMedic/1EMTNoFlyCar
CreateTownEmployeePositions
FY's11 14
3Year
Average
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
revenue
334,303
(89,827)
Adjustments:
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
AddParamedic(5.5FTE's24/7@$100,000/yr)
Reduce1EMT(618MF)
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
0
0
31
22
8760
3120
CostIncreases
orReduced
Revenues
$35,400
$
$
$550,000
$68,640
$30,000
Medications
Equipment
Vehicle
OngoingTrainingCosts(estimated)
$14,000
$45,700
$
$5,000
Fuel
Maintenance/Tires
$
$
$10,000.0
$134,040.0
$624,700.0 $(490,660.0)
$(580,486.7)

Rationale
Captureallknowncosts
Forecastreplacementcosts
Understaterecoveryratesforbillings(80%)
Beconservative,includecontingencyonoperatingcosts
Anticipatecostshighercostsincreasesforfuel
Userealisticcostincreases(3%/year)
Usemoderaterateincreases(2%/year)
Applysensitivityofplus10%/minus10%todemonstratebest/worst/likelycases
Projectgrowththatneverexceeds92%ofhighestrecentyearcallvolume
CompareModels:
RecommendedOptions:
Commercialparamedicstaffing24hours/daywithflycar+2EMT's
Commercialparamedicstaffing24hours/day+1EMT(flycaroffhoursonly)
Commercialparamedicstaffing24hours/day+1EMT(noflycar)
NotRecommended:
DowngradetoBLS
CreateTownofCantonParamedicEmployeepositions
CompletelyOutsourceParamedicLevelService(includingbasicEMS)
Town of Canton
Fire & EMS
Tabular
Comparison of
Service Levels
Section 5
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
Non-rebreather face mask
Upper airway suctioning
Partial rebreathers
Venturi mask
CPAP
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
AEMT
Partial rebreathers
Venturi mask
CPAP
EMT

EMR
Scope of Interventions by Levels of Service
Airway
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
Oral and Nasal airways

Esophageal-Tracheal
Multi-Lumen Airways
Paramedic
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
Humidifiers
Partial rebreathers
Venturi mask
Manually Triggered
Ventilator (MTV)
Automatic Transport
Ventilator (ATV)
Esophageal-Tracheal
Multi-Lumen Airways
BiPAP/CPAP
Needle chest
decompression
Chest tube monitoring
Percutaneous
cricothyrotomy2
ETCO2/Capnography
Assessment
Manual BP
EMR
EMR
Pharmacological Interventions
Unit dose auto-injectors
for self or peer care
EMT
Manual BP
Pulse oximetry
Manual and auto BP
Blood glucose monitor
AEMT
Paramedic
NG/OG tube
Nasal and oral
Endotracheal intubation
Airway obstruction
removal by direct
laryngoscopy
PEEP
Manual BP
Pulse oximetry
Manual and auto BP
Manual BP
Pulse oximetry
Manual and auto BP
EKG interpretation
Interpretive 12 Lead
Blood chemistry analysis

Paramedic
Assisted Medications
Assisting a patient in
administering his/her
own prescribed
medications, including
auto-injection
Tech of Med
Administration
Buccal
Oral
Administered Meds
PHYSICIAN-approved
over-the-counter
medications (oral
glucose, ASA for chest
AEMT

own prescribed
auto-injection
Tech of Med
Administration
Buccal
Oral
Administered Meds
PHYSICIAN-approved
over-the-counter
medications (oral
EMT
own prescribed
auto-injection
Tech of Med
Administration
Buccal
Oral
Administered Meds
PHYSICIAN-approved
over-the-counter
medications (oral
Trauma Care
EMR
Manual cervical stabilization
Manual extremity stabilization
Eye irrigation
Direct pressure
Hemorrhage control
Emergency moves for endangered
patients
pain of suspected
ischemic origin)
Naloxone
EMT
Eye irrigation
Direct pressure
Hemorrhage control
patients
Spinal immobilization
Seated spinal immobilization
Long board
Extremity splinting
pain of suspected
ischemic origin)
Peripheral IV insertion
IV fluid infusion
Naloxone
AEMT
Eye irrigation
Direct pressure
Hemorrhage control
patients
Long board
Extremity splinting
pain of suspected
ischemic origin)
Peripheral IV insertion
IV fluid infusion
Central line monitoring
IO insertion
Venous blood sampling
Tech of Med
Administration
Endotracheal
IV (push and infusion)
NG
Rectal
IO
Topical
Accessing implanted
Central IV port
Administered Meds
PHYSICIAN-approved medications
Paramedic
Maintenance of blood
administration
Thrombolytics
initiation

Eye irrigation
Direct pressure
Hemorrhage control
patients
Long board
Extremity splinting
Cardiac/Medical Care
EMR
CPR
AED
Assisted normal delivery
Traction splinting
Mechanical pt restraint
Tourniquet
MAST/PASG
Cervical collar
Rapid extrication
EMT
CPR
AED
Mechanical CPR
Assisted complicated delivery
Traction splinting
Tourniquet
MAST/PASG
Cervical collar
Rapid extrication
AEMT
CPR
AED
Mechanical CPR
Traction splinting
Tourniquet
MAST/PASG
Cervical collar
Rapid extrication
Morgan lens
Paramedic
CPR
AED
Mechanical CPR
Cardioversion
Carotid massage
Manual defibrillation
TC pacing
Town of Canton
Fire & EMS
Timeline/
Schedule
Section 6
ID
FollowupBOSMeeting(ifrequired)
FollowupBOSMeeting(ifrequired)
AwardContract
13
AwardContracts/PO's
18
24
23
22
21
20
NewServiceLevelIsActive(ALSorBLS)
SupportforAEMTends
ReviewBillingProtocols/Recovery
ReviewProposals
17
19
RequestforProposalsforEquipment
16
15
AcquireRequiredEquipment
ReviewProposals
12
14
RequestforProposalsforALSStaffing/Outsourcing
NotificationtoDPHOEMSforPSAR
11
10
BoardofFinance
PresenttoBoardofSelectmen
SubmitInformationtoBOS/CAO
TaskName
0days
0days
0days
20days
30days
1day
0days
30days
30days
0days
0days
0days
0days
Duration
Finish
Tue9/1/15
Thu8/20/15
Fri7/10/15
Page1
Fri7/1/16
Thu6/30/16
Fri7/1/16
Thu6/30/16
Tue12/15/15 Tue12/15/15
Tue11/17/15 Mon12/14/15
Wed10/7/15 Tue11/17/15
Wed10/7/15 Wed10/7/15
Tue9/1/15
Fri7/10/15
Mon6/1/15
Tue12/23/14 Tue12/23/14
Wed12/10/14 Wed12/10/14
Tue11/25/14 Tue11/25/14
Mon11/3/14 Mon11/3/14
Start
TownofCanton
ChangeinServicePlanningSchedule
2015
Q1
12/23
12/10
11/25
11/3
Q4
Q2
Q3
9/1
Q4
12/15
2016
Q1
Q2
7/1
6/30
Q3
Town of Canton
Fire & EMS
Scalability and
Exit Strategy
Section 7

Canton, Connecticut
Scalability and Exit Strategy

Scalability:
Several options for transitioning to paramedic level service for the Town were explored. The
range of approaches included:
a. Provide paramedic coverage for Monday through Friday 06:00 to 18:00
b. Provide paramedic coverage for seven days per week 06:00 to 18:00
c. Provide paramedic coverage 24/7/365 with a single EMT utilizing the existing Car 10
d. Provide paramedic coverage 24/7/365 with a single EMT utilizing the existing Car 10
plus a fly car for off hours only (18:00 to 06:00 and weekend shifts)
e. Provide paramedic coverage 24/7/365 with two EMT utilizing the existing Car 10 plus a
new fly car
Providing part-time coverage as described in options a and b would not solve for the response
time issues for hours when the paramedic is not under contract. It would also require
maintaining agreements with UConn medics and the same shared billing that exists currently.
Options c, d and e provide full-time paramedic coverage for the Town. Option e provides the
maximum flexibility to respond to the most number of calls in Town along with the greatest
potential utilization of all existing apparatus.
If a decision is made to start with a medic and EMT in the existing ambulance it is possible to
scale up by adding a second EMT to the paid staff during the weekday shifts. This marginal
increase in costs provides immediate expanded service. The medic could use the second
ambulance for responding to calls. While not ideal it is a cost conservative approach. Option d
provides for the best, most scalable solution by introducing the fly car to the equation.
If the value of the expanded service is demonstrated a medic fly car could be added to the
operations and the ultimate in staffing, service and flexibility would be achieved.
Exit Strategy:
Two primary strategies exist if it is decided that the option employed does not work for the
Town.
If after operating the paramedic level service it is determined to be economically unfeasible then
the Town could elect to terminate the service agreement with the staffing company and liquidate
the equipment procured at start-up.
If it is determined that the paramedic level of service is working practically but receivables are
inconsistent with continuation the Town could elect to solicit proposals to completely outsource
the emergency medical services and liquidate all equipment and apparatus. This decision would
effectively disband the volunteer emergency medical service in Town.
Town of Canton
Fire & EMS
EMS Study
Committee
Report
Section 8
Town of Canton
Fire & EMS
Reference
Materials
BOS EMS Subcommittee Report

University of Connecticut Medical Center Memorandum
Jewel Mullen, MD DPH Memo to OPM
DPH CT EMS PSAR Task Force Report
General Assembly Bill 416
Section 9
February
14
Connecticut Emergency Medical Services

Primary Service Area Task Force
Final Report
A Task Force within the Department of Public Health

410 Capitol Avenue, MS#12 EMS, PO Box 340308 Hartford, CT 06134 -0308
CONNECTICUT EMERGENCY MEDICAL SERVICES 2

PRIMARY SERVICE AREA TASK FORCE
Executive Summary
The regulation of Emergency Medical Services (EMS) at the state level is the
responsibility of the Department of Public Health. Services are delivered by way
of a variety of organizational structures at the local level: commercial, nonprofit,
volunteer, and sometimes combination organizations that are a hybrid of these
structures.
Given the short 6-month duration of the Task Force, as well as the complexities
of the EMS System, the Connecticut Emergency Medical Services Task Force
offers the following recommendations in response to the given charge:
Task Force Charge
1. The process for designating
changing a primary service area;
Task Force Recommendation

and 1. Recommendation #5.
Strike a balance between
empowering municipalities and
protecting statewide system stability.
2. Improvements to local primary service 2. Recommendations # 1 and #2

area
contract
and
applicable
subcontract language and emergency
DPH shall conduct a review of all
medical services plans, including
Local EMS Plans at least every 5
provisions of such contracts and plans
years.
relating to performance measures and
oversight by municipalities of primary
Appendix E: Local EMS Plan
service area responders;
Template
3. A. process for expanding or enhancing 3. Recommendation #5
emergency medical services offered in
local primary service areas;
4. A mechanism for reporting adverse 4. Recommendation # 4
events to the Department of Public
Health and for said department to issue
The criteria and process for removal
a response; and
of a PSAR is more specifically
defined
5. An
outreach
plan
to
educate 5. Appendix C: Roles and
municipalities on their rights and duties
Responsibilities Related to the EMS
as
holders
of
contracts
and
PSA System
subcontracts for primary service area
responders
Appendix D: Explanation of the Local
EMS Plan Template
Final Report Approved February 7, 2014

Table of Contents
Executive Summary
Table of Contents
Background
Events Leading Up to the Creation of the Task Force
Task Force Composition
PSA System Analysis
Recommendation #1:
Changes to the Local EMS Plan
Recommendation #2:
DPH Shall Review Local EMS Plans Every 5 Years
10
Recommendation #3
Sale or Transfer of a PSAR
11
Recommendation #4
Removal of a PSAR
12
Task Force Position Statements on Recommendation #5
14
Position Statement
Submitted by Opponents of Recommendation #5
15
Position Statement
Submitted by Proponents of Recommendation #5
17
Recommendation #5:
Alternative Provision of PSA Responsibilities
18
Conclusion
19
Appendix A: Enabling Legislation

Appendix B: Task Force Members
Appendix C: Roles and Responsibilities Related to the EMS PSA System
Appendix D: Explanation of the Local EMS Plan Template
Appendix E: The Local EMS Plan Template
20
24
26
28
29

Background
The PSA Concept
The concept of Primary Service Areas (PSA) was introduced in Connecticut in
1974. A PSA is a specific geographic area that is served exclusively by an
emergency medical services (EMS) provider. The State of Connecticut
Department of Public Health (DPH) designates this provider. Only the Primary
Service Area Responder (PSAR) designated by the State may answer
emergency calls in the specified geographic area. These geographic areas may
include or be within the boundaries of a municipality, tax district, tribal entity or
other specifically identified areas. For the purposes of this report, they shall be
referred to as municipalities.
The statement of intent prefacing the 1974 regulations cited the stacking of
emergency calls, rotation lists, and a lack of accountability as some of the more
serious problems that were to be eliminated by the PSA System. It was the
States intent to provide a statewide system of emergency medical services and
a coordinated response to emergency calls.
The designation of PSARs assigned statutory and regulatory responsibilities to
individual providers. It also defined levels of accountability for the coordinated
emergency medical response and patient care in specific geographic areas, thus
promoting statewide stability.
Levels of Service
There are four PSAR levels of EMS recognized and regulated by the State. They
are First Responder, Basic Ambulance, Intermediate, and Paramedic. The levels
differ in the level of training and skills performed by personnel, as well as
equipment required. Each geographic area should have at least one PSAR
designated for each level of service.
The DPH is required to assign a PSAR for each level of service for every
municipality in the state. Public Health regulations establish the factors that are
to be considered when designating an EMS provider as a PSAR. A single PSAR
may be certified or licensed to provide one or more of these levels of service.

The DPH reports that it has designated the following PSAs:

PSAR Level
First Responder
Intermediate
Basic Ambulance
Paramedic
Quantity of PSAs Assigned by

DPH
218
4
186
125
* Supplemental First Responder is not a recognized PSA Level, however there

are 83 services in the state that presently operate in this capacity.
The DPHs records reflect that at the time of this report, there are specific levels
of service that have not been assigned to a PSAR in a number of communities.
The lack of a designated PSAR for a specific level of service could ether indicate
that the State has not designated a provider or that the service is not being
provided.
The PSAR System has remained relatively unchanged for the last quarter
century. The DPH reports that the majority of PSA designations, approximately
155, were assigned in 1989. In the past two years, DPH reported that only three
PSAs were issued. All three of these PSAs were issued in 2013.
Relevant Features of the Current PSA System
A provider only needs to go through the application process once. The PSAR is
an indefinite assignment.
A PSA must be open in order for a provider to apply. The PSA generally would
be considered open if the PSA was currently unassigned, the current PSA
holder surrendered its assignment, or that assignment was revoked by DPH.
DPH records revealed that the department has not revoked any PSARs within
the last decade.
DPH reported that no petitions to remove a PSAR were filed, however a number
of concerns were brought to the attention of the department for technical
assistance.
If a PSAR holding a PSA Designation is merged or sold, DPH and the
municipality served exercises limited oversight over transaction.

Only five broad standards related to PSAs exist in the current Statutes and
Regulations.
Current Statutes and Regulations Related to PSAs
1. PSARs are required to respond to all emergency calls 24 hours a day, 7
days a week. There is no defined response time standard in the
Regulations of Connecticut State Agencies Sec. 19a-179-11. Availability
of response services
2. PSARs may lose their assignments if OEMS determines it is in the best
interests of patient care to do so; as prescribed in the Regulations of
Connecticut State Agencies Sec. 19a-179-4(d) as well as CGS Sec. 19a177(12) and CGS Sec. 19a-181c (c).
3. Municipalities may petition the commissioner to suspend a PSA holder if
the chief administrative officer can demonstrate that an emergency exists
and that the safety, health, and welfare of the citizens of the affected area
are jeopardized by the performance of the PSA responder. In accordance
with CGS Sec. 19a-181c (b) and the Regulations of Connecticut State
Agencies Sec. 19a-179-4(e).
The performance of the responder is unsatisfactory based on the Local
EMS Plan established by the municipality pursuant to CGS Sec. 19a-181c
(b) and associated agreements or contracts.
4. If any licensed or certified ambulance service fails to submit required EMS
information for a specified period of time, the Commissioner may take
action in accordance with CGS Sec. 19a-177-8(a)(c).
5. A municipality may petition the Commissioner, not more than once every
three years, for the removal of a PSAR on the grounds of unsatisfactory
performance in accordance with CGS Sec. 19a-181c (b).

Events Leading Up to the Creation of the Task Force

The current PSA process in Connecticut has recently received a significant
amount of attention and critical review.
Municipal leaders renewed their efforts for PSA system reform in 2012.
Legislation was proposed that would Enhance the delivery of local public safety
by allowing local municipalities the discretion to determine how local ambulance
services are delivered within their communities. The committee took no action
on the bill.
In the 2013 Legislative Session, two bills were raised: House Bill 5999 and
House Bill 6518. The Public Health Committee convened a Public Hearing on
HB 6518. A variety of stakeholders including, but not limited to, municipal
officials, commercial and volunteer ambulance service providers, career and
volunteer fire departments, and others provided testimony. Substitute for Raised
H.B. No. 6518
The legislature determined that further study of the PSA system was warranted.
This created the Task Force that was established in Public Act No.13-306
(Appendix A).
Task Force Composition
The Connecticut EMS PSA Task Force was comprised of 15 members who
represented all geographic areas of EMS delivery at the State, County, City, and
Town levels. Task Force Members represented commercial and municipal EMS
agencies, including career, volunteer, and combination fire, police, and EMS
services; as well as municipal, state, and hospital representatives. The Task
Force Members also represented centuries of combined experience in EMS
delivery in basic and advanced life support as well as the supervisory,
managerial, and executive levels.

PSA System Analysis

Task Force Members completed an evaluation of the Strengths, Weaknesses,
Opportunities, and Threats (SWOT) of the current PSA System.
Strengths
EMS system stability
Cost control
Lack of political interference
Regionalization
Weaknesses
Municipalities have limited or no input in choosing or changing their PSAR
Municipalities and PSARs are not proficient with current State Statutes and
Regulations that pertain to the PSA System
Historically inconsistent application of current Statutes and Regulations
There have not been recent updates to State Statutes and Regulations
Opportunities
Establish a foundation for statewide performance standards that are
measurable, achievable and objective, which include review and enforcement
components
Streamline the process for municipalities to change providers based on nonperformance
Evaluate the status of Local EMS Plans
Use data to identify opportunities for additional education of all system
stakeholders
Establish periodic reviews for all Local EMS Plans
Threats
Increasing demand for services
Decrease in reimbursements
Erosion of trust between municipalities and PSAR holders due to a lack of
transparency and inclusion
Challenges created by oversight of 169 municipalities
Potential for deregionalization
EMS system fragmentation and isolation
The Task Force Members used the results of their collective SWOT Analysis as
the basis for the recommendations being offered in this report.

Recommendation #1: Changes to the Local EMS Plan

It shall be the responsibility of each municipality or authority having jurisdiction to
update its Local Emergency Medical Services Plan (Local EMS Plan) which is
required by CGS 19a-181b, to respond to the dynamic needs of their community,
as well as specify EMS objectives and performance measures necessary to meet
the local community needs. The municipality shall consult with the current PSAR
when updating their Local EMS Plan. Municipalities and PSARs shall avail
themselves of technical services available through DPH to resolve
disagreements arising from the creation or implementation of the Local EMS
Plan.
In the event that the existing PSAR refuses to deliver the requisite level of care
identified in the updated Local EMS Plan, the municipality may petition DPH for
removal of the PSAR in accordance with CGS 19a-181d.

PRIMARY SERVICE AREA TASK FORCE 0
Recommendation #2: DPH Shall Review Local EMS Plans Every 5 Years
DPH shall conduct a review of the EMS delivery system in every municipality in
Connecticut a minimum of every five years.
Such review shall include, and independently evaluate, the following elements for
compliance with CGS 19a-181b and relevant OEMS Regulations:
1. The applicable Local EMS Plan
2. Performance of all levels of assigned PSARs
DPH shall assign a rating of Meeting Performance Standards, Exceeding
Performance Standards, or Failure to Comply with Performance Standards for
each PSA reviewed.
Failure to comply may result in a DPH approved improvement plan with periodic
follow-up reviews with a 6-month time frame, subject to the approval of both the
municipality and the PSAR. Further failure to comply may result in DPH removal
of PSA assignment.
It is the position of the Task Force that Appendix E, The Local EMS Plan
Template shall be the basis for all Local EMS Plans.

Recommendation #3: Sale or Transfer of a PSAR

Any PSAR that sells or transfers all of its assets to another entity, or has more
than fifty percent of its ownership interest sold or transferred to another entity,
shall notify the DPH of such sale or transfer no later than sixty (60) days prior to
the sale or transfer. The purchasing entity shall file an application with the DPH
for approval of the sale or transfer of such PSA Assignment on a form prescribed
by the DPH. DPH shall review such application based on the following criteria:
1. Background of purchasing entity
2. Purchasing entitys compliance history in other jurisdictions
3. Financial ability to perform the responsibilities of a PSAR in Connecticut in
compliance with the local EMS Plan
DPH shall solicit input from impacted municipalities and sponsor hospitals prior to
making a determination on the disposition of the PSA Assignments. The DPH
shall complete its review within 45 days of receipt of the purchasing entitys
application.

Recommendation #4: Removal of a PSAR

Section 19a-181c should seek to define the terms that enable municipalities to
remove a responder:
An emergency should be defined to include, but not be limited to:
1. Designated PSAR fails to respond to at least 50% of all first call responses
in any rolling 3 month review period and fails to implement a mutually
agreed upon corrective action plan.
2. Sponsor Hospital of the designated PSAR will not endorse or provide
recommendation of PSAR as the designated provider based on defined
and unresolved issues with the quality of care rendered to patients.
Unsatisfactory performance should be defined to include, but not limited to:
1. Designated PSAR fails to respond to at least 80% of all first call responses
(excluding approved exceptions) in any rolling 12 month review period and
fails to implement a mutually agreed upon corrective action plan.
2. Designated PSAR fails to meet defined response time standards
(excluding approved exceptions) negotiated by a community and the
designated PSAR and fails to implement a mutually agreed upon
corrective action plan.
3. Designated PSAR repeatedly fails to investigate and respond to
complaints related to quality of emergency care and response.
4. Designated PSAR repeatedly fails to report adverse events as mandated
by DPH, or as mutually agreed upon by provider and municipality in the
Local EMS plan.
5. Designated PSAR communicates (or municipality becomes aware of) the
intent of the PSAR to change the level of service to a level that is
inconsistent with the Local EMS Plan or could potentially affect patient
outcome negatively.
6. Designated PSAR fails to communicate changes in the level of service or
coverage patterns that materially affect the delivery of service as outlined
in the Local EMS Plan.
7. Designated PSAR fails to communicate changes in organizational
structure of the PSAR that materially affect the delivery of service as
outlined in the Local EMS Plan
If an emergency is alleged, DPH shall take action within 5 business days and
conclude an investigation within 30 days. In an alleged emergency, the

Department may develop a system of providing emergency medical services to

the community served by the PSAR.
If they allege unsatisfactory performance, DPH shall take action within 15
business days and come to a determination within 90 days. Extensions shall be
permissible when necessary.
DPH shall have the latitude to reclassify any petition within the Emergency and
Unsatisfactory Performance categories based on the findings of its investigation.

Task Force Position Statements on Recommendation #5

This is the only recommendation in this report that does not carry the unanimous
endorsement of all of the Task Force Members. This recommendation was
approved by a simple majority of the Task Force Members who participated in
the meeting.

Position Statement Submitted by Opponents of Recommendation #5:

The Task Force has reached consensus on all items except for certain language
relating to the replacement of Primary Service Area Responders (PSARs)
designated as Item 5 (issue in dispute). Proponents of this language believe that
DPH should allow municipalities to remove PSARs at any time subject to a
showing to DPH that the municipalities or their contractors are capable of
operating the PSAs. In other words, there would be no requirement to show
"cause" to replace the existing PSARs. Opponents of Item 5 believe such a
proposal is an unjustifiable and fundamental change to an EMS system that has
worked so well for thirty years. Allowing municipalities to remove PSARs without
cause would have a number of serious negative consequences, including but not
limited to the following:
1. PSARs will be unwilling to invest the capital necessary to most effectively
operate the PSA if they can be removed at anytime.
2. Coordination of regional medical control will suffer with frequent changes in
PSARs and their personnel.
3. There will be disparate levels of EMS services throughout the State, where
more affluent communities can demand and afford to pay for better levels of EMS
care.
4. Conversely, those economically disadvantaged communities that were able to
take advantage of regional coverage by EMS providers will be either forced to
pay more for the current level of coverage or allow the level of EMS services to
decline.
5. Frequent changes to PSARs will result in a greater chance for
miscommunication and coordination problems among municipalities in the region
when mutual aid is required or in the event of mass casualties.
6. The elimination of regional coverage, which is currently provided by
commercial providers who hold a number of PSAs in the same region, will make
the EMS system more fractured and less cost effective.
Because of the need for a statewide system approach, primary service area
responders should not be removed unless they have not met accepted
performance standards and there is a risk to the health & safety of residents in a
community. In 2000, the State legislature conducted a comprehensive review of
the PSA system in Connecticut and passed legislation that made PSARs more
accountable to municipalities, allowed municipalities to create performance
standards and goals for their communities through local EMS Plans and provided
a mechanism for municipalities to remove those PSARs, who did not meet those
performance standards. Unfortunately, few municipalities have developed local

EMS Plans and no community has attempted to remove a PSAR under the
statutory mechanism provided. Supporters of a "for cause" removal process
respectfully suggest that municipalities utilize the existing tools provided by the
legislature before seeking a fundamental legislative change which will have major
negative consequences on a very good EMS system. Allowing municipalities to
seek removal of an EMS PSAR without cause and without consideration of the
impact on the entire statewide system is not in the best interest of the residents
of the Connecticut.
Indiscriminate removal of any PSARs would likely
compromise Connecticuts delicate statewide system and existing mutual aid
agreements by focusing solely on the individual municipality.

Position Statement Submitted by Proponents of Recommendation #5

1. The PSA System is almost 40 years old. It needs to be updated to
incorporate the elements of best practice, transparency and home rule; all of
which are rudimentary elements of good public policy.
2. The current PSA system is essentially a monopoly. There is no notion of
competitiveness factored into the market for emergency medical calls.
Municipalities may contract with only the provider assigned to them to obtain
better performance or higher level of service. Due to the methods of PSA
assignment, this service cannot be bid on the open market. Monopolies are
not good government.
3. PSA Holders are able to surrender a PSA at will if they no longer chose to
provide the service. Municipalities are not granted that same right; presently
a municipality is not able to have a PSA removed if the municipality no longer
wishes to have the service provided by the PSA Holder.
4. It should be the role of the municipality to select their provider. It should be
the role of DPH to ensure that Local EMS Plans comply with the law and
those EMS providers meets the required criterion. Home rule is a
fundamental aspect of the laws and traditions of every New England state.
5. No provider should continue to enjoy an entitlement to a PSA. A PSA should
never be viewed as a commodity that may be bought and sold. The ability of
a municipality to review and change EMS providers will provide EMS
companies cause to ensure that their quality of service remain at the highest
level and are provided at reasonable costs. Competition for services keeps
providers alert and attuned to their own costs and quality.
6. Municipalities routinely go out to bid for proposals to determine the best way
to provide a variety of services as a matter of best practice. EMS should be
no exception.
This recommendation has evolved throughout the duration of the Task Force and
includes significant input from those who represent both sides of the debate.
In response to concerns about stability for the States EMS system, carefully
crafted language was incorporated into the proposal to create a process for the
DPH to evaluate and impose oversight secondary to a request to change PSARs.
This process creates an appropriate venue for entities with a desire for change to
constructively address those concerns with the guidance of the DPH.
PSARs have enjoyed almost 40 years of having the right to be the exclusive
provider of EMS in their designated geographic areas within the State of
Connecticut. The current PSA System allows these providers to continue to
profit from this privilege indefinitely, provided they meet only the minimum
requirements. It is not unexpected that these PSARs would support the status
quo so that they can indefinitely reap the benefits of this designation without
concern for having to improve their service delivery or otherwise react to the
dynamic needs of the community that they are designated to serve.

Recommendation #5: Alternative Provision of PSA Responsibilities

Municipalities shall have the right to submit a Local EMS Plan for consideration
to DPH for the alternative provision of primary service area responder
responsibilities.
In the event that the updated Local EMS Plan demonstrates that said
municipality is positioned to deliver EMS Service, or contract to have EMS
Service delivered through a responder other than that which is currently
designated by the state, DPH shall develop a process to assure the matter is
heard and make a determination regarding the aforementioned plan.
A municipality may submit a Local EMS Plan to DPH for consideration of the
alternative provision of primary service area responsibilities for the following
reasons - this is not an all-inclusive list:
Improved patient care
More efficient EMS delivery
More efficient allocation of resources
Opportunity to align with a new EMS provider better suited to meet the
communitys current needs
Regionalization possibilities
Response times
When making a determination on the disposition of a plan for the alternative
provision of primary service area responder responsibilities, DPH shall consider
the following factors. This is not an all-inclusive list:
Impact on patient care
Local EMS Plan and all related factors
EMS System Design including system sustainability
Impact on the local, regional and statewide EMS System
Recommendation from Medical Control / Sponsor Hospital
DPH shall reassign the PSA in accordance with the Local EMS Plan if the
hearing results in a favorable review of the alternative provision for the primary
service area responsibilities. The provider named in the Local EMS Plan must
then apply and be approved by DPH for the PSA Assignment in accordance with
OEMS Regulations 19a-179-4 in advance of the reassigned PSA Assignment
becoming effective.

Conclusion
The Connecticut EMS PSA Task Force was made up of professionals who are
dedicated to the quality delivery of EMS to all people in the State of Connecticut.
The Task Force applied their cumulative years of experience and training to
complete its legislated charges.
Each member of the Task Force appreciates the dedication and time of their
counterparts. Task Force members also appreciate and thank the members of
the Connecticut Legislature, Connecticut Department of Public Health Staff, and
the public who attended meetings and offered insightful comments. Input from all
of these interested parties was seriously considered by the Task Force.
In conclusion, the Task Force recommends that the Connecticut Legislature
continue the effort to reform and adjust the EMS PSA system using this report as
an exceptional and enabling resource which supports needed changes to an
EMS system that is so critically vital to the citizens of the State of Connecticut.

Appendix A: Enabling Legislation
Substitute House Bill No. 6518
Public Act No. 13-306

AN ACT CONCERNING THE STANDARDS OF PROFESSIONAL CONDUCT
FOR EMERGENCY MEDICAL SERVICE PERSONNEL AND ESTABLISHING
AN EMERGENCY MEDICAL SERVICES PRIMARY AREA TASK FORCE.
Be it enacted by the Senate and House of Representatives in General Assembly
convened:
Section 1. Section 20-206nn of the general statutes is repealed and the following is
substituted in lieu thereof (Effective October 1, 2013):
The Commissioner of Public Health may take any disciplinary action set forth in
section 19a-17 against a paramedic, emergency medical technician, emergency
medical responder, advanced emergency medical technician or emergency
medical services instructor for any of the following reasons: (1) Failure to
conform to the accepted standards of the profession; (2) conviction of a felony, in
accordance with the provisions of section 46a-80; (3) fraud or deceit in obtaining
or seeking reinstatement of a license to practice paramedicine or a certificate to
practice as an emergency medical technician, emergency medical responder,
advanced emergency medical technician or emergency medical services
instructor; (4) fraud or deceit in the practice of paramedicine, the provision of
emergency medical services or the provision of emergency medical services
education; (5) negligent, incompetent or wrongful conduct in professional
activities; (6) physical, mental or emotional illness or disorder resulting in an
inability to conform to the accepted standards of the profession; (7) alcohol or
substance abuse; or (8) wilful falsification of entries in any hospital, patient or
other health record. [; or (9)] The commissioner may take any such disciplinary
action against a paramedic for violation of any provision of section 20-206jj or
any regulations adopted pursuant to section 20-206oo. The commissioner may
order a license or certificate holder to submit to a reasonable physical or mental
examination if his or her physical or mental capacity to practice safely is the

subject of an investigation. The commissioner may petition the superior court for
the judicial district of Hartford to enforce such order or any action taken
pursuant to section 19a-17. The commissioner shall give notice and an
opportunity to be heard on any contemplated action under said section 19a-17.
Sec. 2. Section 19a-195a of the general statutes is repealed and the following is
substituted in lieu thereof (Effective October 1, 2013):
(a) The Commissioner of Public Health shall adopt regulations in accordance
with the provisions of chapter 54 to provide that emergency medical technicians
shall be recertified every three years. For the purpose of maintaining an
acceptable level of proficiency, each emergency medical technician who is
recertified for a three-year period shall complete thirty hours of refresher
training approved by the commissioner, or meet such other requirements as may
be prescribed by the commissioner.
(b) The commissioner shall adopt regulations, in accordance with the provisions
of chapter 54, to (1) provide for state-wide standardization of certification for
each class of (A) emergency medical technicians, including, but not limited to,
paramedics, (B) emergency medical services instructors, and (C) [medical
response technicians] emergency medical responders, (2) allow course work for
such certification to be taken state-wide, and (3) allow persons so certified to
perform within their scope of certification state-wide.
Sec. 3. (Effective from passage) (a) There is established, within the Department of
Public Health and within available appropriations, the Connecticut emergency
medical services primary service area task force. The task force shall review
topics, including, but not limited to, the following: (1) The current process for
designating and changing primary service areas; (2) local primary service area
contract and applicable subcontract language and emergency medical services
plans as such language and plans vary among municipalities and as such
contracts and plans pertain to performance and oversight measures; (3) methods
to designate emergency medical service providers that are used by other states
that have populations, geography and emergency medical services systems that
are similar to those of this state; and (4) the process by which municipalities may
petition for a change or removal of a primary service area responder.
(b) The task force shall consist of the following members:
(1) Five members appointed by the Commissioner of Public Health, one each of
whom shall be: (A) A representative of a municipal emergency medical services
provider; (B) a representative of a for-profit ambulance service; (C) a
representative of the Connecticut Hospital Association; (D) a representative of a

nonprofit emergency medical services provider; and (E) a representative of the

emergency medical services advisory board, established pursuant to section 19a178a of the general statutes;
(2) Two appointed by the speaker of the House of Representatives, one each of
whom shall be the chief elected official or an administrator of a municipality, and
a representative of a municipal public safety board, public safety agency, or
municipal legislative body;
(3) Two appointed by the president pro tempore of the Senate, one each of whom
shall be the chief elected official or an administrator of a municipality, and a
representative of an emergency medical services provider that primarily
provides fire services;
(4) One appointed by the majority leader of the House of Representatives, who
shall be a fire chief or representative of a fire department that provides
emergency medical services;
(5) One appointed by the majority leader of the Senate, who shall be a fire chief
or representative of a fire department that provides emergency medical services;
(6) One appointed by the minority leader of the House of Representatives, who
shall be a representative of a not-for-profit emergency medical services provider;
(7) One appointed by the minority leader of the Senate, who shall be a chief
elected official or an administrator of a municipality;
(8) One appointed, jointly by the minority leader of the House of Representatives
and the minority leader of the Senate, who shall be a representative of the
Association of Connecticut Ambulance Providers; and
(9) The Commissioner of Public Health, or the commissioner's designee.
(c) Each person making an appointment pursuant to subsection (b) of this section
shall ensure that each member who is associated with a municipality or
municipal entity represents a different municipality.
(d) The Commissioner of Public Health, or the commissioner's designee, shall
serve as a cochairperson of the task force. The members shall elect another
person to serve as a cochairperson from among the members of the task force.
(e) Members shall receive no compensation except for reimbursement for
necessary expenses incurred in performing their duties.

(f) All appointments to the task force shall be made not later than thirty days
after the effective date of this section. The Commissioner of Public Health or the
commissioner's designee shall schedule the first meeting of the task force. A
majority of the task force members shall constitute a quorum. A majority vote of
a quorum shall be required for any official action of the task force.
(g) The administrative staff of the Department of Public Health shall serve as
administrative staff of the task force.
(h) Not later than February 15, 2014, the task force shall report, in accordance
with the provisions of section 11-4a of the general statutes, to the joint standing
committee of the General Assembly having cognizance of matters relating to
public health concerning its activities, as described in subsection (a) of this
section. Such report shall include, but need not be limited to, recommendations
concerning: (1) The process for designating and changing a primary service area;
(2) improvements to local primary service area contract and applicable
subcontract language and emergency medical services plans, including
provisions of such contracts and plans relating to performance measures and
oversight by municipalities of primary service area responders; (3) a process for
expanding or enhancing emergency medical services offered in local primary
service areas; (4) a mechanism for reporting adverse events to the Department of
Public Health and for said department to issue a response; and (5) an outreach
plan to educate municipalities on their rights and duties as holders of contracts
and subcontracts for primary service area responders.
(i) The task force shall submit its report on February 15, 2014. The task force shall
terminate on the date it submits its report.
Approved July 12, 2013

Appendix B: Task Force Members

Task Force Member
Appointing Authority
1.
A representative of a
municipal emergency
medical services provider
Commissioner of Public
Health, Jewel Mullen
Gary Wiemokly
Director of EMS
Town of Enfield
Appointee
2.
A representative of a forprofit ambulance service
Fred Della Valle /

Charles Babson
American Medical Response
3.
A representative of the
Connecticut Hospital
Association
Carl Schiessl
Director of Regulatory Advocacy
Connecticut Hospital Association
4.
nonprofit emergency
Joseph Danao
Deputy Chief
Gardner Lake Volunteer Fire
Company Salem
5.
A representative of the
emergency medical
services advisory board,
established pursuant to
section 19a-178a of the
general statute
Charlee Tufts
Executive Director
Greenwich EMS
6.
The chief elected official

or an administrator of a
municipality
Speaker of the House of

Representatives Brendan
Sharkey
Mary-Ellen Harper
Director of Fire & Rescue
Services
Town of Farmington
7.
municipal public safety
board, public safety
agency, or municipal
legislative body
Speaker of the House of

Representatives Brendan
Sharkey
Task Force Co-Chair

Paul Fitzgerald
Police Chief
Town of Berlin
8.
The chief elected official

or an administrator of a
municipality
President Pro Tempore of

the Senate Donald
Williams
Matthew Galligan
Town Manager
South Windsor
9.
A representative of an
emergency medical
services provider that
primarily provides fire
services
President Pro Tempore of

the Senate Donald
Williams
Thomas G. Ronalter
Fire Chief
New Britain Fire Department
Brooklyn, Canterbury,
Killingly, Mansfield,
Putnam, Scotland,
Thompson & Windham

Task Force Member
Appointing Authority
10. A fire chief or

representative of a fire
department that provides
emergency medical
services;
11. A fire chief or
representative of a fire
department that provides
emergency medical
services
Majority Leader of the

House of Representatives,
Joe Aresimowicz,
12. A representative of a notfor-profit emergency

Minority Leader of the

House of Representatives
Lawrence Cafero
Bruce Baxter
Chief
New Britain EMS
13. A chief elected official or

an administrator of a
municipality;

Senate John McKinney
Caroline Calderone Baisley

Director
Greenwich Department of Health
Berlin and Southington

Majority Leader of the
Senate Martin M. Looney
Appointee
Seth Roberts
West Haven Fire Dept.
Vincent Landisio
Fire Chief
North Haven Fire Department
New Haven, Hamden &

North Haven
Easton, Fairfield, Newtown,

Weston & Westport
14. A representative of the
Association of Connecticut
Ambulance Providers;
Appointed jointly by the

House of Representatives
and the Minority Leader of
the Senate, Lawrence
Cafero and John McKinney
David Lowell
Executive Vice President/Chief
Operating Officer
Hunters Ambulance
Meriden, CT
Norwalk and New Canaan

Easton, Fairfield, Newtown,
Weston & Westport
15. The Commissioner of
Public Health, or the
commissioner's designee
Health Jewel Mullen
Raphael M. Barishansky
Director
Office of Emergency Medical
Services
Task Force Co-Chair

Appendix C: Roles and Responsibilities Related to the EMS PSA System

Please find this memo to describe to municipalities their rights, roles and
responsibilities under the existing Connecticut emergency medical services
(EMS) primary service area (PSA) system.
Presently, the Connecticut Department of Public Health (CT-DPH) assigns
exclusive emergency (911) geographic coverage areas or PSAs to individual
EMS organizations. These assignments are of indefinite duration and rely
heavily on local municipal oversight and engagement to assure continued EMS
care delivery that meets local community standards. Variations in population
density and geography, as well as other factors, make response-time standards
and the level of EMS care delivery a very local decision based on community
priorities and resources. Municipalities must take an active role in planning their
EMS system and all of the requisite components in order to assure optimal
outcomes for their constituents.
In order to improve municipal engagement and oversight of their local EMS
systems, Connecticut Public Act 00-151 required all municipalities to develop
local EMS plans. The legislation defined minimum criteria for these plans and
identified groups and officials ideally suited to assist in their development. One
of the most important required elements of these plans was supposed to be
performance measures for each component of the system (i.e. dispatch, first
responders, ambulance, and paramedics.) Each municipality has the right to
negotiate performance contracts with their EMS primary service area responder
(PSAR) as an element of the Local EMS planning process. These performance
measures then serve as the basis for on-going evaluation of local EMS providers.
When a municipality and its EMS providers are unable to reach an agreement on
establishing reasonable performance standards, CT-DPH is authorized to
mediate through a hearing process to establish a set of reasonable performance
standards.
Providing safe and appropriate patient care services while adhering to
established performance standards is requisite to an EMS PSARs continued
operation within their assigned geographic area.
When either of these
requirements are not met, municipalities are empowered by C.G.S. Sec. 19a181c to petition CT-DPH to remove the PSAR. These matters would be handled
through a formal hearing process. The CT-DPH commissioner may then
determine to remove the PSAR for either of these reasons or if such removal is
determined to be in the best interests of patient care.
The Department has assigned EMS coordinators to each of the states five
regions. Upon request, these coordinators are qualified and available to assist
municipalities with local EMS planning, establishment of performance measures
or addressing issues related to system improvement.

It is incumbent upon both municipalities and the EMS agencies that service them
to avail themselves of all opportunities for communication on issues of mutual
concern.
The Office of Emergency Medical Services looks forward to working with both
EMS agencies and municipalities to strengthen the statewide EMS system.

Appendix D: Explanation of the Local EMS Plan Template

The effectiveness of Connecticuts EMS system is dependent on the
identification and coordination of EMS resources. Local EMS Plans should relate
to sub-region, regional and statewide integration of EMS assets.
The Local EMS Plan is an instrument to identify a communitys EMS resources,
performance expectations and state of readiness for emergency medical
response within and between communities. EMS system planning is a dynamic
process and the Local EMS Plan should be used to establish standards and set
goals and should be amended as necessary.
Connecticut General Statutes, Sec. 19a-181b. Local EMS Plan.
(a) Not later than July 1, 2002. Each municipality shall establish a Local EMS
Plan. Such plan shall include the written agreements or contracts developed
between the municipality, its EMS providers and the public safety answering
point, as defined in section 28-25 that covers the municipality. The plan shall
also include, but not be limited to, the following:( 1) The identification of levels of
EMS, including, but not limited to: (A) The public safety answering point
responsible for receiving emergency calls and notifying and assigning the
appropriate provider to a call for EMS; (B) the EMS provider that is notified for
initial response; (C) basic ambulance service; (D) advanced life support level;
and (E) mutual aid call arrangements; (2) The name of the person or entity
responsible for carrying out each level of EMS that the plan identifies;(3) The
establishment of performance standards for each segment of the municipality's
EMS system; and (4) Any subcontracts, written agreements or mutual aid call
agreements that EMS providers may have with other entities to provide services
identified in the plan.
(b)In developing the plan required by subsection (a) of this section, each
municipality: (1) May consult with and obtain the assistance of its regional EMS
council established pursuant to section 19a-183, its regional EMS coordinator
appointed pursuant to section 19a-185, its regional EMS medical advisory
committees and any sponsor hospital, as defined in regulations adopted
pursuant to section 19a-179, located in the area identified in the plan; and (2)
shall, submit the plan to its regional EMS council for the council's review and
comment.
The intent of the law is for each of the 169 municipalities in Connecticut to
develop a Local EMS Plan and develop written agreements or performance
based contracts. Your Regional EMS Council is available to provide you
assistance and consultation. It is recommended that the chief executive officer
and/or chief elected official of the municipality convene a meeting of people to
include the EMS chief, police chief, fire chief, local health director, hospital
representatives, when developing the Local EMS Plan.

Appendix E: The Local EMS Plan Template
LOCAL EMS PLAN

Revision Date: ___/___/_____
Municipality/ Authority of Jurisdiction_______________________ Tax Code #_______________
Description of area if other than full geographic boundary:
________________________________________________________________
_________________________________________________________________________________________________
Address _________________________________________Zip Code_________
Name of municipal CEO______________________________________________________________________
Name and title of person completing this form____________________________________________
Contact Tel. #____________________________________ Fax # ___________________________________
E-mail Address _______________________________________________________________________________
I. 9-1-1 PUBLIC SAFETY ANSWERING POINT (PSAP)

1. Name of the PSAP that receives 9-1-1 calls from the public for your municipality
_________________________________________________________________________________________________
2. Is your 9-1-1 PSAP also the entity that dispatches your EMS provider services?
___ Yes ___No
If no, identify who provides EMS dispatch of your EMS providers.
_________________________________________________________________________________________________
3. What Emergency Medical Dispatch (EMD) product is utilized in the
municipality? ________________________________________________________________________________
4. Name of sponsor hospital for EMD Program providing medical direction and
quality assurance oversight:
________________________________________________________________________________________________
5. Name of Medical Director:

________________________________________________________________________________________________
6. What EMD performance standards have you set for your PSAP?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
II.
LIST OF EMS REPONDERS SERVING YOUR MUNICIPALITY

(If necessary, add additional lines to list additional EMS provider services)
A. FIRST RESPONDER SERVICE

_________________________________________________________________________________________________
1. Chief of Service __________________________________________________________________________
2. Address of Service
_________________________________________________________________________________________________
3. Is this service the assigned primary service area responder? _____Yes
______No
If yes, list the geographical boundaries of the primary service area.

________________________________________________________________________________________________
4. Does the service provide AED as first responder? ____________Yes _______________No
5. Who provides mutual-aid coverage to the First Responder service?
_________________________________________________________________________________________________
6. Do you have a written mutual-aid agreement for First Responder service?
_________________________________________________________________________________________________
7. Does this service respond to other municipalities for mutual aid? _____Yes _____No
If yes, list municipalities: ___________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. Identify the desired response time* performance standards for the First
Responder response in fractile format:
Under ____ Minutes ____ % of responses for light and siren emergency responses.
Under ____ Minutes ____ % of responses for non-light and siren emergency
responses.

9. Identify the target percent of the total EMS first call requests to be answered by
the PSAR in a 12 month period:
_________________________________________________________________________________________________
10. Name of sponsor hospital providing medical direction and quality assurance
oversight:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
B. SUPPLEMENTAL FIRST RESPONDER (if applicable)
_________________________________________________________________________________________________
1. Chief of Service __________________________________________________________________________
________________________________________________________________________________________________
3. Is this service the assigned primary service area responder? _______Yes _______No
________________________________________________________________________________________________
4. Does the service provide AED as first responder? _______________Yes _____________No
5. Who provides mutual-aid coverage to the First Responder service?
_________________________________________________________________________________________________
6. Do you have a written mutual-aid agreement for First Responder service?
_________________________________________________________________________________________________
7. Does this service respond to other municipalities for mutual aid? ____Yes _______No
If yes, list municipalities: ___________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. Identify the desired response time* performance standards for the Supplemental
First Responder response in fractile format:
Under ____ Minutes ____ % of responses for light and siren emergency responses.
responses.

the PSAR in a 12-month period:
_____________________________________________________________________________________________
oversight:
_________________________________________________________________________________________________
5. 11. Name of Medical Director:
_________________________________________________________________________________________________
C. BASIC AMBULANCE SERVICE
_________________________________________________________________________________________________
1. Chief of Service ___________________________________________________________________________
_________________________________________________________________________________________________
3. Is this service the assigned primary service area responder? _______Yes _______No
_________________________________________________________________________________________________
4. Who provides mutual-aid coverage to the basic ambulance service?
_________________________________________________________________________________________________
5. Do you have a written mutual-aid agreement for basic ambulance service?
_________________________________________________________________________________________________
6. Does this service respond to other municipalities for mutual aid? _____Yes _____No
If yes, list municipalities: ____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Identify the desired response time* performance standards for the Basic
Ambulance response in fractile format:
Under ____ Minutes ____ % of responses for light and siren emergency
responses.
responses.

_________________________________________________________________________________________________
oversight:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
D. PARAMEDIC SERVICE
________________________________________________________________
1. Chief of Service __________________________________________________________________________
_________________________________________________________________________________________________
3. Is this service the assigned primary service area responder? ________Yes ______No
_________________________________________________________________________________________________
4. Who provides mutual-aid coverage to the paramedic service?
_________________________________________________________________________________________________
5. Do you have a written mutual-aid agreement for paramedic service?
_________________________________________________________________________________________________
6. Does this service respond to other municipalities for mutual aid? ______Yes ____No
If yes, list municipalities: ____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Identify the desired response time* performance standards for the Paramedic
Service response in fractile format:
Under ____ Minutes ____ % of responses for light and siren emergency
responses.
responses.

_________________________________________________________________________________________________
oversight:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
III. OTHER TRAINED/ORGANIZED COMMUNITY RESPONSE

ASSETS:
(I.e. CERT, Medical Response Teams, etc.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
IV. Quality Assurance

1. Describe the process used in the municipality to review EMS System
performance:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
________________________________________________________________________________________________
Is the Sponsor Hospital involved in this process? ________________Yes
____________No
2. Describe the process used for review, maintenance and improvement of the
quality of the delivery of medical care:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Is the Sponsor Hospital involved in this process? ______________Yes ________________No

3. Describe the methodology used to make EMS system improvements within the
municipality:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Describe the process used to document and report adverse events:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Is the Sponsor Hospital informed of adverse events affecting patient care?
_____Yes _____No
V. Community Integration and Public Education of EMS System

1. Are community CPR classes conducted annually in the municipality?
___ Yes ___No
If yes, Describe:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Estimate the % of the population trained in CPR _____%
Does the municipality have a Heart Safe Designation? ___________Yes _____________No
Info:
heartsafe-community org
http://www.ct.gov/dph/lib/dph/communications/hs_brochure.pdf
If Yes, Identify the Heart Safe Data Points? ________________________________________________

_________________________________________________________________________________________________
2. Does the municipality maintain a record of the locations of Automated External
Defibrillators within the community? _______________ _ Yes __________________No
If yes, Describe:_______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. .Does the municipality offer other forms of public education and information
related to its EMS system on a regular and structured basis? _________ Yes _________No
Describe:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
VI. Regional and Statewide Integration

1. Is the municipality and/or provider involved in Regional ESF 8 (Health &
Medical Services) activities and planning?
Municipality Representative?
First Responder Representative?
Basic Ambulance Service Representative?
Paramedic Service Provider Representative?
___ Yes
___ Yes
___ Yes
___ Yes
___No
___No
___No
___No
Describe:
________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
2. Is the municipality and/or provider involved with their Regional EMS Council?
___ Yes
___ Yes
___ Yes
___ Yes
___No
___No
___No
___No
Describe:
________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
3. Is the municipality and/or provider involved in statewide EMS committees,
organizations, activities, etc.?
___ Yes
___ Yes
___ Yes
___ Yes
___No
___No
___No
___No
Describe:
________________________________________________________________________
_________________________________________________________________________________________

_________________________________________________________________________________________
_________________________________________________________________________________________
*For the standardized purpose of this plan, fractile response time at each level
should be based on time of dispatch of the responder to the arrival at scene of
the responder. Communities may measure other elements of response times as a
part of their systems review and planning.
VII. Attachments
All subcontracts, written agreements or mutual aid call agreements that emergency
medical services providers have with other entities to provide services identified in
the plan.
List the document type and date submitted
Document Type
Office
_________________________
Date Submitted/Received by DPH

__________________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
DPH USE ONLY

Date Plan Received: ___________________________________________________
Date(s) Plan
Reviewed
___________
___________
___________
___________
___________
Reviewer Name
________________
________________
________________
________________
________________
Comments
_________________________
_________________________
_________________________
_________________________
_________________________
MEMORANDUM
DATE:
November 1, 2013
TO:
Office of Policy Management Legislative Staff

Governors Office Legislative Staff
FROM:
Jewel Mullen, MD, MPH, MPA, Commissioner

Department of Public Health
RE:
Legislative Proposals for the Year 2014 Session
Please find enclosed, for your review a copy of the Department of Public Healths 2013 Legislative
Proposals.
My staff and I have carefully analyzed the enclosed proposals and feel that these initiatives, if
passed by the General Assembly, will allow the Department to better ensure the quality and delivery
of services to the public. The bills we are submitting in order of priority are:
1. An Act Concerning Various Revisions to the Public Health Statutes
2. An Act Amending the Sovereign Immunity Waiver Regarding the Department of Public
Health
3. An Act Enabling the Department of Public Health to Contract with Other States
4. An Act Concerning Online Applications and License Renewal
5. An Act Concerning Meningococcal Vaccines for College Students Residing on Campus
6. An Act Concerning The Inspection Of Ambulances
7. An Act Concerning Advanced Emergency Medical Technicians
8. An Act Concerning Streamlining the Takeover Proceedings and Certificates of Public
Convenience and Necessity
9. An Act Concerning Medical Orders for Life Sustaining Treatment
10. An Concerning Return of Unexpended Local Health Per-Capita Funds and Proration of
Local Health Per-Capita Funds When Towns Join Health Districts
11. An Act Concerning Nursing Facility Management Services
12. An Act Concerning On-Site Breastfeeding In Day Care Facilities
13. An Act Concerning Genealogists Access to Vital Records Vaults
14. An Act Concerning Reporting Requirements For Radon-Related Disciplines
15. An Act Concerning Electronic Physician Signatures
16. An Act Concerning Penalties for Failure To Comply With A Recall Of Shellfish.
17. An Act Concerning The Freedom of Information Act.
We have forwarded our legislative initiatives to the appropriate administrative agencies. Please let
me know if you have any questions or if I can provide you with additional information. I look
forward to working with you on this agenda.
TABLE OF CONTENTS
An Act Concerning Various Revisions to the Public Health Statutes...3
An Act Amending the Sovereign Immunity Waiver Regarding the
Department of Public Health.42
An Act Enabling the Department of Public Health to Contract with Other States...50
An Act Concerning Online Applications and License Renewal...53
An Act Concerning Meningococcal Vaccines for College Students Residing on Campus..56
An Act Concerning The Inspection Of Ambulances.60
An Act Concerning Advanced Emergency Medical Technicians.....64
An Act Concerning Streamlining the Takeover Proceedings and Certificates of Public
Convenience and Necessity...69
An Act Concerning Medical Orders for Life Sustaining Treatment..76
An Concerning Return of Unexpended Local Health Per-Capita Funds and Proration of Local
Health Per-Capita Funds When Towns Join Health Districts81
An Act Concerning Nursing Facility Management Services.84
An Act Concerning On-Site Breastfeeding In Day Care Facilities...87
An Act Concerning Genealogists Access to Vital Records Vaults..94
An Act Concerning Reporting Requirements For Radon-Related Disciplines.98
An Act Concerning Electronic Physician Signatures..102
An Act Concerning Penalties for Failure To Comply With A Recall Of Shellfish.105
An Act Concerning The Freedom Of Information Act...108
Agency Legislative Proposal - 2014 Session

Document Name (e.g. OPM1015Budget.doc; OTG1015Policy.doc):
GRE will fill in
(If submitting an electronically, please label with date, agency, and title of proposal
092611_SDE_TechRevisions)
State Agency:
Connecticut Department of Public Health
Liaison: Elizabeth Keyes/Jill Kentfield
Phone: (860) 509-7246/(860) 509-7280
E-mail: Elizabeth.keyes@ct.gov/ jill.kentfield@ct.gov
Lead agency division requesting this proposal: Healthcare Quality and Safety Branch, Office of
Emergency Medical Services
Agency Analyst/Drafter of Proposal: Ray Barishansky
Title of Proposal: An Act Concerning Advanced Emergency Medical Technicians

Statutory Reference:
Sec 1. 19a-14 - Powers of department concerning regulated professions.
Sec 2. 19a-178a - Emergency Medical Services Advisory Board established; appointment;
responsibilities.
Sec 3. 19a-179a - Scope of practice of emergency medical technicians and paramedics.
Sec 4. 19a-179d - Implementation of policies and procedures re training, recertification and
reinstatement of certification or licensure of emergency medical service personnel.
Sec 5. 19a-195b - Reinstatement of expired certification. Validity of expired certificate.
Sec 6. 19a-197a - Administration of epinephrine.
Sec 7. 20-206nn - Disciplinary action. Grounds.
Proposal Summary
This proposal eliminates the category of Advanced Emergency Medical Technician (AEMT).
The Department is putting this request forward based upon the advice and recommendation of
the Connecticut Emergency Medical Services Advisory Board (legislatively appointed board)
and the Connecticut Emergency Medical Services Medical Advisory Committee (EMS medical
director physicians from the sponsor hospitals). The currently certified AEMTs in Connecticut
are trained to 1985 National DOT curriculum. The training program is antiquated and the
Department sought advice from industry experts on upgrading the level to the 2009 National
Education Standards. As an aside, there are far fewer AEMTs than any other level of EMS
provider in the State out of the 24,000 licensed and certified EMS personnel in Connecticut,
only 900 are AEMTs. The EMS medical directors from the sponsor hospitals, as well as the EMS
training program directors, have advised the Department that they do not have the infrastructure
to support the upgraded training level for AEMT providers as the increase in training
requirements and continuous maintenance of skill competencies is significant. As the
determination has been made that the 1985 standards have limited clinical value, the elimination
of the level will result in a savings of OEMS personnel time processing the more complex
61
education and certification paperwork.
Please attach a copy of fully drafted bill (required for review)

PROPOSAL BACKGROUND
Reason for Proposal
Please consider the following, if applicable:
(1) Have there been changes in federal/state/local laws and regulations that make this
legislation necessary?
(2) Has this proposal or something similar been implemented in other states? If yes, what is the
outcome(s)?
(3) Have certain constituencies called for this action?
(4) What would happen if this was not enacted in law this session?
Origin of Proposal
___ New Proposal
If this is a resubmission, please share:
___ Resubmission
(1) What was the reason this proposal did not pass, or if applicable, was not included in the
Administrations package?
(2) Have there been negotiations/discussions during or after the previous legislative session to
improve this proposal?
(3) Who were the major stakeholders/advocates/legislators involved in the previous work on this
legislation?
(4) What was the last action taken during the past legislative session?
PROPOSAL IMPACT
Agencies Affected (please list for each affected agency)
Agency Name:
Agency Contact (name, title, phone):
Date Contacted:
Approve of Proposal
___ YES
___NO
___Talks Ongoing
Summary of Affected Agencys Comments
62
Will there need to be further negotiation? ___ YES
___NO
Fiscal Impact (please include the proposal section that causes the fiscal impact and the
anticipated impact)
Municipal (please include any municipal mandate that can be found within legislation)
State
Federal
Additional notes on fiscal impact
Policy and Programmatic Impacts (Please specify the proposal section associated with the
impact)
Sec 1. Subdivision (23) of subsection (c) of section 19a-14 of the general statutes is repealed
and the following is substituted in lieu thereof:
(23) Emergency medical technician, [advanced emergency medical technician,] emergency medical
responder and emergency medical services instructor;
Sec 2. Section 19a-178a of the general statutes is repealed and the following is substituted in
lieu thereof:
63
(a) There is established within the Department of Public Health an Emergency Medical Services
Advisory Board.
(b) The advisory board shall consist of members appointed in accordance with the provisions of this
subsection and shall include the Commissioner of Public Health and the departments emergency
medical services medical director, or their designees. The Governor shall appoint the following
members: One person from each of the regional emergency medical services councils; one person
from the Connecticut Association of Directors of Health; three persons from the Connecticut
College of Emergency Physicians; one person from the Connecticut Committee on Trauma of the
American College of Surgeons; one person from the Connecticut Medical Advisory Committee; one
person from the Emergency Department Nurses Association; one person from the Connecticut
Association of Emergency Medical Services Instructors; one person from the Connecticut Hospital
Association; two persons representing commercial ambulance providers; one person from the
Connecticut Firefighters Association; one person from the Connecticut Fire Chiefs Association; one
person from the Connecticut Chiefs of Police Association; one person from the Connecticut State
Police; and one person from the Connecticut Commission on Fire Prevention and Control. An
additional eighteen members shall be appointed as follows: Three by the president pro tempore of
the Senate; three by the majority leader of the Senate; four by the minority leader of the Senate;
three by the speaker of the House of Representatives; two by the majority leader of the House of
Representatives and three by the minority leader of the House of Representatives. The appointees
shall include a person with experience in municipal ambulance services; a person with experience in
for-profit ambulance services; three persons with experience in volunteer ambulance services; a
paramedic; an emergency medical technician; [an advanced emergency medical technician;] three
consumers and four persons from state-wide organizations with interests in emergency medical
services as well as any other areas of expertise that may be deemed necessary for the proper
functioning of the advisory board.
lieu thereof:
Notwithstanding any provision of the general statutes or any regulation adopted pursuant to this
chapter, the scope of practice of any person certified or licensed as an emergency medical
[technician] responder, [advanced] emergency medical technician or a paramedic under regulations
adopted pursuant to section 19a-179 may include treatment modalities not specified in the
regulations of Connecticut state agencies, provided such treatment modalities are (1) approved by
the Connecticut Emergency Medical Services Medical Advisory Committee established pursuant to
section 19a-178a and the Commissioner of Public Health, and (2) administered at the medical
oversight and direction of a sponsor hospital, as defined in section 28-8b.
Sec 4. Section 19a-179d of the general statutes is repealed and the following is substituted in
lieu thereof:
Notwithstanding the provisions of subdivision (1) of subsection (a) of section 19a-179 and section
19a-195b, the Commissioner of Public Health may implement policies and procedures concerning
training, recertification and reinstatement of certification or licensure of emergency medical
responders, emergency medical technicians[, advanced emergency medical technicians] and
paramedics, while in the process of adopting such policies and procedures in regulation form,
provided the commissioner prints notice of the intent to adopt regulations in the Connecticut Law
Journal not later than thirty days after the date of implementation of such policies and procedures.
64
Policies implemented pursuant to this section shall be valid until the time final regulations are
adopted.
Sec 5. Section 19a-195b of the general statutes is repealed and the following is substituted in
lieu thereof:
(a) Any person certified as an emergency medical technician, [advanced emergency medical
technician,] emergency medical responder or emergency medical services instructor pursuant to this
chapter and the regulations adopted pursuant to section 19a-179 whose certification has expired may
apply to the Department of Public Health for reinstatement of such certification as follows: (1) If
such certification expired one year or less from the date of application for reinstatement, such
person shall complete the requirements for recertification specified in regulations adopted pursuant
to section 19a-179, as such recertification regulations may be from time to time amended; (2) if
such certification expired more than one year but less than three years from the date of application
for reinstatement, such person shall complete the training required for recertification and the
examination required for initial certification specified in regulations adopted pursuant to section
19a-179, as such training and examination regulations may be from time to time amended; or (3) if
such certification expired three or more years from the date of application for reinstatement, such
person shall complete the requirements for initial certification specified in regulations adopted
pursuant to section 19a-179, as such initial certification regulations may be from time to time
amended.
(b) Any certificate issued pursuant to this chapter and the regulations adopted pursuant to section
19a-179 which expires on or after January 1, 2001, shall remain valid for ninety days after the
expiration date of such certificate. An such certificate shall become void upon the expiration of such
ninety-day period.
lieu thereof:
[(a) As used in this section, emergency medical technician means (1) any class of emergency
medical technician certified under regulations adopted pursuant to section 19a-179, including, but
not limited to, any advanced emergency medical technician, and (2) any paramedic licensed
pursuant to section 20-206ll. (b)] Any emergency medical technician or paramedic who has been
trained, in accordance with national standards recognized by the Commissioner of Public Health, in
the administration of epinephrine using automatic prefilled cartridge injectors or similar automatic
injectable equipment and who functions in accordance with written protocols and the standing
orders of a licensed physician serving as an emergency department director may administer
epinephrine using such injectors or equipment. All emergency medical technicians and paramedics
shall receive such training. All licensed or certified ambulances shall be equipped with epinephrine
in such injectors or equipment which may be administered [in accordance with written protocols
and standing orders of a licensed physician serving as an emergency department director] under the
medical oversight and direction of a sponsor hospital, as defined in section 28-8b.
Sec 7. Section 20-206nn of the general statutes is repealed and the following is substituted in
lieu thereof:
65
The Commissioner of Public Health may take any disciplinary action set forth in section 19a-17
against a paramedic, emergency medical technician, emergency medical responder[, advanced
emergency medical technician] or emergency medical services instructor for any of the following
reasons: (1) Failure to conform to the accepted standards of the profession; (2) conviction of a
felony, in accordance with the provisions of section 46a-80; (3) fraud or deceit in obtaining or
seeking reinstatement of a license to practice paramedicine or a certificate to practice as an
emergency medical technician, emergency medical responder[, advanced emergency medical
technician] or emergency medical services instructor; (4) fraud or deceit in the practice of
paramedicine, the provision of emergency medical services or the provision of emergency medical
services education; (5) negligent, incompetent or wrongful conduct in professional activities; (6)
physical, mental or emotional illness or disorder resulting in an inability to conform to the accepted
standards of the profession; (7) alcohol or substance abuse; or (8) wilful falsification of entries in
any hospital, patient or other health record. The commissioner may take any such disciplinary
action against a paramedic for violation of any provision of section 20-206jj or any regulations
adopted pursuant to section 20-206oo. The commissioner may order a license or certificate holder to
submit to a reasonable physical or mental examination if his or her physical or mental capacity to
practice safely is the subject of an investigation. The commissioner may petition the superior court
for the judicial district of Hartford to enforce such order or any action taken pursuant to section 19a17. The commissioner shall give notice and an opportunity to be heard on any contemplated action
under said section 19a-17.
66
General
Assembly
February Session,
2014
Raised Bill No.

416
LCO No. 2058
*02058_______PH_*
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S
RECOMMENDATIONS REGARDING ADVANCED EMERGENCY
MEDICAL TECHNICIANS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-175 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective January 1, 2017):
As used in this chapter, unless the context otherwise requires:

(1)"Emergency medical service system" means a system [which] that
provides for the arrangement of personnel, facilities and equipment for
the efficient, effective and coordinated delivery of health care services
under emergency conditions;
(2)"Patient" means an injured, ill, crippled or physically handicapped
person requiring assistance and transportation;
(3)"Ambulance" means a motor vehicle specifically designed to carry
patients;
(4)"Ambulance service" means an organization [which] that transports
patients;
(5)"Emergency medical technician" means an individual who has
successfully completed the training requirements established by the
commissioner and has been certified by the Department of Public Health;
(6)"Ambulance driver" means a person whose primary function is driving
an ambulance;
(7)"Emergency medical services instructor" means a person who is
certified by the Department of Public Health to teach courses, the
completion of which is required in order to become an emergency medical
technician;
(8)"Communications facility" means any facility housing the personnel
and equipment for handling the emergency communications needs of a
particular geographic area;
(9)"Life saving equipment" means equipment used by emergency medical
personnel for the stabilization and treatment of patients;
(10)"Emergency medical service organization" means any organization
whether public, private or voluntary [which] that offers transportation or
treatment services to patients under emergency conditions;
(11)"Invalid coach" means a vehicle used exclusively for the transportation

of nonambulatory patients, who are not confined to stretchers, to or from
either a medical facility or the patient's home in nonemergency situations
or utilized in emergency situations as a backup vehicle when insufficient
emergency vehicles exist;
(12)"Rescue service" means any organization, whether profit or nonprofit,
whose primary purpose is to search for persons who have become lost or
to render emergency service to persons who are in dangerous or perilous
circumstances;
(13)"Provider" means any person, corporation or organization, whether
profit or nonprofit, whose primary purpose is to deliver medical care or
services, including such related medical care services as ambulance
transportation;
(14)"Commissioner" means the Commissioner of Public Health;
(15)"Paramedic" means a person licensed pursuant to section 20-206ll;
(16)"Commercial ambulance service" means an ambulance service [which]
that primarily operates for profit;
(17)"Licensed ambulance service" means a commercial ambulance service
or a volunteer or municipal ambulance service issued a license by the
commissioner;
(18)"Certified ambulance service" means a municipal or volunteer
ambulance service issued a certificate by the commissioner;
(19)"Management service" means an employment organization that does
not own or lease ambulances or other emergency medical vehicles and
that provides emergency medical technicians or paramedics to an
emergency medical service organization;
(20)"Automatic external defibrillator" means a device that: (A) Is used to
administer an electric shock through the chest wall to the heart; (B)
contains internal decision-making electronics, microcomputers or special

software that allows it to interpret physiologic signals, make medical
diagnosis and, if necessary, apply therapy; (C) guides the user through the
process of using the device by audible or visual prompts; and (D) does not
require the user to employ any discretion or judgment in its use;
(21)"Mutual aid call" means a call for emergency medical services that,
pursuant to the terms of a written agreement, is responded to by a
secondary or alternate emergency medical services provider if the primary
or designated emergency medical services provider is unable to respond
because such primary or designated provider is responding to another call
for emergency medical services or the ambulance or nontransport
emergency vehicle operated by such primary or designated provider is
out of service. For purposes of this subdivision, "nontransport emergency
vehicle" means a vehicle used by emergency medical technicians or
paramedics in responding to emergency calls that is not used to carry
patients;
(22)"Municipality" means the legislative body of a municipality or the
board of selectmen in the case of a municipality in which the legislative
body is a town meeting;
(23)"Primary service area" means a specific geographic area to which one
designated emergency medical services provider is assigned for each
category of emergency medical response services;
(24)"Primary service area responder" means an emergency medical
services provider who is designated to respond to a victim of sudden
illness or injury in a primary service area;
(25)"Interfacility critical care transport" means the interfacility transport of
a patient between licensed hospitals;
[(26)"Advanced emergency medical technician" means an individual who
is certified as an advanced emergency medical technician by the
Department of Public Health;]
[(27)] (26) "Emergency medical responder" means an individual who is

certified as an emergency medical responder by the Department of Public
Health;
[(28)] (27) "Medical oversight" means the active surveillance by physicians
of mobile intensive care sufficient for the assessment of overall practice
levels, as defined by state-wide protocols;
[(29)] (28) "Mobile intensive care" means prehospital care involving
invasive or definitive skills, equipment, procedures and other therapies;
[(30)] (29) "Office of Emergency Medical Services" means the office
established within the Department of Public Health Services pursuant to
section 19a-178; and
[(31)] (30) "Sponsor hospital" means a hospital that has agreed to maintain
staff for the provision of medical oversight, supervision and direction to
an emergency medical service organization and its personnel and has
been approved for such activity by the Office of Emergency Medical
Services.
Sec. 2. Subsection (c) of section 19a-14 of the 2014 supplement to the
general statutes is repealed and the following is substituted in lieu thereof
(Effective January 1, 2017):
(c)No board shall exist for the following professions that are licensed or
otherwise regulated by the Department of Public Health:
(1)Speech and language pathologist and audiologist;
(2)Hearing instrument specialist;
(3)Nursing home administrator;
(4)Sanitarian;
(5)Subsurface sewage system installer or cleaner;
(6)Marital and family therapist;

(7)Nurse-midwife;
(8)Licensed clinical social worker;
(9)Respiratory care practitioner;
(10)Asbestos contractor and asbestos consultant;
(11)Massage therapist;
(12)Registered nurse's aide;
(13)Radiographer;
(14)Dental hygienist;
(15)Dietitian-Nutritionist;
(16)Asbestos abatement worker;
(17)Asbestos abatement site supervisor;
(18)Licensed or certified alcohol and drug counselor;
(19)Professional counselor;
(20)Acupuncturist;
(21)Occupational therapist and occupational therapist assistant;
(22)Lead abatement contractor, lead consultant contractor, lead
consultant, lead abatement supervisor, lead abatement worker, inspector
and planner-project designer;
(23)Emergency medical technician, [advanced emergency medical
technician,] emergency medical responder and emergency medical
services instructor;
(24)Paramedic;
(25)Athletic trainer;
(26)Perfusionist;
(27)Master social worker subject to the provisions of section 20-195v;
(28)Radiologist assistant, subject to the provisions of section 20-74tt;
(29)Homeopathic physician;
(30)Certified water treatment plant operator, certified distribution system
operator, certified small water system operator, certified backflow
prevention device tester and certified cross connection survey inspector,
including certified limited operators, certified conditional operators and
certified operators in training; and
(31)Tattoo technician.
The department shall assume all powers and duties normally vested with
a board in administering regulatory jurisdiction over such professions.
The uniform provisions of this chapter and chapters 368v, 369 to 381a,
inclusive, 383 to 388, inclusive, 393a, 395, 398, 399, 400a and 400c,
including, but not limited to, standards for entry and renewal; grounds for
professional discipline; receiving and processing complaints; and
disciplinary sanctions, shall apply, except as otherwise provided by law,
to the professions listed in this subsection.
Sec. 3. Subsections (a) and (b) of section 19a-178a of the general statutes
are repealed and the following is substituted in lieu thereof (Effective
January 1, 2017):
(a) There is established within the Department of Public Health an
Emergency Medical Services Advisory Board.
(b)The advisory board shall consist of members appointed in accordance
with the provisions of this subsection and shall include the Commissioner
of Public Health and the department's emergency medical services

medical director, or their designees. The Governor shall appoint the
following members: One person from each of the regional emergency
medical services councils; one person from the Connecticut Association of
Directors of Health; three persons from the Connecticut College of
Emergency Physicians; one person from the Connecticut Committee on
Trauma of the American College of Surgeons; one person from the
Connecticut Medical Advisory Committee; one person from the
Emergency Department Nurses Association; one person from the
Connecticut Association of Emergency Medical Services Instructors; one
person from the Connecticut Hospital Association; two persons
representing commercial ambulance providers; one person from the
Connecticut Firefighters Association; one person from the Connecticut
Fire Chiefs Association; one person from the Connecticut Chiefs of Police
Association; one person from the Connecticut State Police; and one person
from the Connecticut Commission on Fire Prevention and Control. An
additional eighteen members shall be appointed as follows: Three by the
president pro tempore of the Senate; three by the majority leader of the
Senate; four by the minority leader of the Senate; three by the speaker of
the House of Representatives; two by the majority leader of the House of
Representatives and three by the minority leader of the House of
Representatives. The appointees shall include a person with experience in
municipal ambulance services; a person with experience in for-profit
ambulance services; three persons with experience in volunteer
ambulance services; a paramedic; [an] two emergency medical
[technician] technicians; [an advanced emergency medical technician;]
three consumers and four persons from state-wide organizations with
interests in emergency medical services as well as any other areas of
expertise that may be deemed necessary for the proper functioning of the
advisory board.
Sec. 4. Section 19a-179a of the general statutes is repealed and the
Notwithstanding any provision of the general statutes or any regulation
adopted pursuant to this chapter, the scope of practice of any person
certified or licensed as an emergency medical [technician,advanced]

responder, emergency medical technician or a paramedic under
regulations adopted pursuant to section 19a-179 may include treatment
modalities not specified in the regulations of Connecticut state agencies,
provided such treatment modalities are (1) approved by the Connecticut
Emergency Medical Services Medical Advisory Committee established
pursuant to section 19a-178a, as amended by this act, and the
Commissioner of Public Health, and (2) administered at the medical
oversight and direction of a sponsor hospital, as defined in section 28-8b.
Sec. 5. Section 19a-179d of the general statutes is repealed and the
Notwithstanding the provisions of subdivision (1) of subsection (a) of
section 19a-179 and section 19a-195b, as amended by this act, the
Commissioner of Public Health may implement policies and procedures
concerning training, recertification and reinstatement of certification or
licensure of emergency medical responders, emergency medical
technicians [, advanced emergency medical technicians] and paramedics,
while in the process of adopting such policies and procedures in
regulation form, provided the commissioner prints notice of the intent to
adopt regulations, [in the Connecticut Law Journal] in accordance with
the provisions of chapter 54 of the general statutes, not later than thirty
days after the date of implementation of such policies and procedures.
Policies implemented pursuant to this section shall be valid until the time
final regulations are adopted.
Sec. 6. Section 19a-195b of the general statutes is repealed and the
(a) Any person certified as an emergency medical technician, [advanced
emergency medical technician,] emergency medical responder or
emergency medical services instructor pursuant to this chapter and the
regulations adopted pursuant to section 19a-179 whose certification has
expired may apply to the Department of Public Health for reinstatement
of such certification as follows: (1) If such certification expired one year or
less from the date of application for reinstatement, such person shall
complete the requirements for recertification specified in regulations

adopted pursuant to section 19a-179, as such recertification regulations
may be from time to time amended; (2) if such certification expired more
than one year but less than three years from the date of application for
reinstatement, such person shall complete the training required for
recertification and the examination required for initial certification
specified in regulations adopted pursuant to section 19a-179, as such
training and examination regulations may be from time to time amended;
or (3) if such certification expired three or more years from the date of
application for reinstatement, such person shall complete the
requirements for initial certification specified in regulations adopted
pursuant to section 19a-179, as such initial certification regulations may be
from time to time amended.
(b)Any certificate issued pursuant to this chapter and the regulations
adopted pursuant to section 19a-179 [which] that expires on or after
January 1, 2001, shall remain valid for ninety days after the expiration date
of such certificate. Any such certificate shall become void upon the
expiration of such ninety-day period.
Sec. 7. Section 19a-197a of the general statutes is repealed and the
[(a) As used in this section, "emergency medical technician" means (1) any
class of emergency medical technician certified under regulations adopted
pursuant to section 19a-179, including, but not limited to, any advanced
emergency medical technician, and (2) any paramedic licensed pursuant
to section 20-206ll.]
[(b)] Any emergency medical technician or paramedic who has been
trained, in accordance with national standards recognized by the
Commissioner of Public Health, in the administration of epinephrine
using automatic prefilled cartridge injectors or similar automatic injectable
equipment and who functions in accordance with written protocols and
the standing orders of a licensed physician serving as an emergency
department director may administer epinephrine using such injectors or
equipment. All emergency medical technicians and paramedics shall
receive such training. All licensed or certified ambulances shall be

equipped with epinephrine in such injectors or equipment [which] that
may be administered [in accordance with written protocols and standing
orders of a licensed physician serving as an emergency department
director] under the medical oversight and direction of a sponsor hospital,
as defined in section 28-8b.
Sec. 8. Section 20-206nn of the 2014 supplement to the general statutes is
repealed and the following is substituted in lieu thereof (Effective January
1, 2017):
The Commissioner of Public Health may take any disciplinary action set
forth in section 19a-17 against a paramedic, emergency medical technician,
emergency medical responder [, advanced emergency medical technician]
or emergency medical services instructor for any of the following reasons:
(1) Failure to conform to the accepted standards of the profession; (2)
conviction of a felony, in accordance with the provisions of section 46a-80;
(3) fraud or deceit in obtaining or seeking reinstatement of a license to
practice paramedicine or a certificate to practice as an emergency medical
technician, emergency medical responder, advanced emergency medical
technician or emergency medical services instructor; (4) fraud or deceit in
the practice of paramedicine, the provision of emergency medical services
or the provision of emergency medical services education; (5) negligent,
incompetent or wrongful conduct in professional activities; (6) physical,
mental or emotional illness or disorder resulting in an inability to conform
to the accepted standards of the profession; (7) alcohol or substance abuse;
or (8) wilful falsification of entries in any hospital, patient or other health
record. The commissioner may take any such disciplinary action against a
paramedic for violation of any provision of section 20-206jj or any
regulations adopted pursuant to section 20-206oo. The commissioner may
order a license or certificate holder to submit to a reasonable physical or
mental examination if his or her physical or mental capacity to practice
safely is the subject of an investigation. The commissioner may petition
the superior court for the judicial district of Hartford to enforce such order
or any action taken pursuant to section 19a-17. The commissioner shall
give notice and an opportunity to be heard on any contemplated action

under said section 19a-17.
Sec. 9. Subdivision (5) of subsection (a) of section 19a-904 of the general
statutes is repealed and the following is substituted in lieu thereof
(Effective January 1, 2017):
(5) "Emergency medical technician" means any class of emergency medical
technician certified under regulations adopted pursuant to section 19a179, including, but not limited to, any [advanced emergency medical
technician or] emergency medical responder;
This act shall take effect as follows and shall amend
the following sections:
Section 1 January 1, 2017
19a-175
Sec. 2
January 1, 2017
19a-14(c)
Sec. 3
January 1, 2017
19a-178a(a) and (b)
Sec. 4
January 1, 2017
19a-179a
Sec. 5
January 1, 2017
19a-179d
Sec. 6
January 1, 2017
19a-195b
Sec. 7
January 1, 2017
19a-197a
Sec. 8
January 1, 2017
20-206nn
Sec. 9
January 1, 2017
19a-904(a)(5)
Statement of Purpose:
To implement the Department of Public Health's recommendations
concerning advanced emergency medical technicians.
[Proposed deletions are enclosed in brackets. Proposed additions are
indicated by underline, except that when the entire text of a bill or resolution or
a section of a bill or resolution is new, it is not underlined.]
Peter Canning, Paramedic, R.N.

EMS History 1989-2014
Clinical
Full Time Paramedic, American Medical Response and previously L&M Ambulance, Hartford 1995-2014
EMT-Intermediate, Bloomfield Volunteer Ambulance, 1993-1995, East Windsor Volunteer Ambulance
1991-1993
EMT, Eastern Ambulance, Springfield, Mass, 1989-1992. Part Time
Education
Nurse (Associates Degree) - 2009 - Excelsior College, Albany, New York
Critical Care Paramedic 2002 - University of Baltimore, Maryland
Paramedic 1992-1993 UCONN Health Center Paramedic Class, Farmington, CT
Emergency Medical Technician- Intermediate 1991, East Windsor, CT
Emergency Medical Technician 1989- Springfield College, Springfield, CT
Hospital-Based
EMS Coordinator, John Dempsey Hospital 2008-2014
Highlights- Increased pain management usage by 1000% percent, instituted STEMI Alert process that
led to record Door to balloon times, opened up SIm lab to paramedics, presented multiple CMEs,
including latest EMS research.
State Government
Executive Assistant to Health Commissioner Susan Addiss/Aide to Governor Weicker, Connecticut
Department of Health Services , 1991-1995
Highlights-Directed Health Departments revitalization of EMS, restored OEMS to stand alone division,
revived defunct EMS Advisory Committee, created separate reporting structure for Medical Advisory to
report directly to commissioner, hired permanent OEMS director, made development of trauma
regulations a department priority, negotiated settlement with Governors office to preserve funding for
regional councils and their coordinators.
Regional Involvement
Paramedic representative to Medical Advisory Committee and Educational Standards Committee, 20012008, John Dempsey Representative to committees 2008-2014, Board of Directors Member 2010-2014
Highlights-Led regional guidelines and policies development helping make North Central most
progressive and emulated regional guidelines in state; policies included DNR, lights and sirens,
interaction with law enforcement, pain control, STEMI Alert, spinal immobilization and chemical
restraint
Community
Organized and Led EMS Rally at State Capitol protesting dismantling of EMS agency, which eventually
led to reversal of Commissioners policies. May 19, 1997
Led successful effort to change state laws to enable paramedics to give controlled substances on
standing orders, Worked with regional, state, and federal officials to prepare case, testified before state
legislature. March 2, 2000.
Co-Chairman of American Heart Association Mission Lifeline STEMI Accelerator Project Paramedic
Training Committee. Helped organize and lectured at Paramedic STEMI Conference attended by over
100 regional paramedics, authored STEMI workbook given to all participants. September 2013
Humanitarian
Medical Missions to Dominican Republic with Saint Francis Hospital Surgical Team, functioned as
paramedic and translator. May 2005, May 2006
Hurricane Katrina - Deployed to Gulfport Mississippi in aftermath of Hurricane to assist with 911
operations. September 2005
Writing
Internationally published author and EMS commentator
Books
Paramedic on the Front Lines of Medicine (Fawcett 1998), picked by New York Public Library as one of
outstanding books of 1998, selection of Literary Guild. Translated into Japanese. Nonfiction memoir.
Rescue 471: A Paramedics Stories (Ballantine 2000). Nonfiction memoir.
Mortal Men: Paramedics on the Streets of Hartford (Dystel 2012), Novel.
Blogs
Street Watch: Notes of a Paramedic (www.medicscribe.com); 2006-2013; original member of JEMS
Fireemsblogs network, entries have been published in JEMS and EMS World, regular featured postings
on www.jems.com
Capnography for Paramedics (www.emscapnography.blogspot.com) Established in 2006, Number 1
reference site on capnography for paramedics .
Awards
CCEP - Connecticut Chapter Emergency Medical Physicians Non-Physician of the Year Award 1994 for
contributions to statewide EMS Development
Recognized by CORC Committee of Regional Chairpersons for contributions to EMS - 1994
EMS Champions Award- Saint Francis Hospital 2011 For outstanding care and EMS contributions as a
paramedic.
Speaking Engagements
Mission LifeLine Paramedic Conference, John Dempsey Case Presentation, Early Notification/STEMI
Alert, West Hartford , CT, September 2013
EMS Masters Series, Meriden, CT, Cardiac Resuscitation, April 2013
New Britain EMS Education and Leadership Symposium, October 2010
Presented multiple CMEs at Saint Francis Hospital, Hartford Hospital, New Britain EMS, Backus Hospital,
American Medical Response- West Hartford, Farmington Fire, East Hartford Fire, and Keene Medical
Center, New Hampshire and other locations on Pain Management, STEMI Care, and Capnography,
among other topics.
Monthly Presenter at John Dempsey Hospital CMEs 2008-2013
Presented at Ct EMS Conference in past years on Capnography and Writing in EMS

11.25.14 Paramedic Recommendation

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Town of Canton

Fire & EMS

November 18, 2014

Fire and EM S Departm ent

RE: Emergency Medical Services Upgrade to Paramedic

upgrade in service is to full-time commercially staffed paramedics with a fly-car utilizing

John Bunnell BA, NREMT-P

Town of Canton Fire & EMS

Options for Emergency Service Levels

Tabular Comparison of Levels of Service

Scalability and Exit Strategy

EMS Study Committee Report dated September 7, 2012

BOS EMS Subcommittee Report dated 2-25-13

General Assembly Bill 416 Raised in February 2014 Session

Jewel Mullen, MD DPH Memo to Office of Policy Management November 1, 2013

Town of Canton Fire & EMS

Review and approval by Town of Canton Board of Selectmen

Towns with Paramedic Service

Town of Canton Fire & EMS

Outsource for Paramedic Staffing (eliminate AEMT)

Not Recommended Options:

Downgrade to BLS/Continue Paramedic Service from UConn Medical Center

Create Town of Canton Paramedic Employee positions

Completely Out-source Paramedic Level Service (Aetna, AMR, Campion, Hunters,

Downgrade to Basic Life Support

Create Town of Canton Paramedic Employee Positions

Completely Out-source Paramedic Level Service

Outsource for Paramedic Staffing (eliminate AEMT)

Outsource Paramedic Staffing (maintain two EMTs add fly car)

Town of Canton Volunteer Fire and EMS

- Laryngoscope Blades (Mac 1-4, Miller 0-4)

- Lifepak 15 Cardiac Monitor/Defibrillator

Town of Canton Volunteer Fire and EMS

Ford Explorer or Chevy Tahoe

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Town of Canton Volunteer Fire and EMS

Scope of Interventions by Levels of Service

Oral and Nasal airways

Oral and Nasal airways

Unit dose auto-injectors

Unit dose auto-injectors

Manual cervical stabilization

Town of Canton Fire & EMS

Scalability and Exit Strategy

BOS EMS Subcommittee Report

Connecticut Emergency Medical Services

A Task Force within the Department of Public Health

CONNECTICUT EMERGENCY MEDICAL SERVICES 2

Task Force Recommendation

2. Improvements to local primary service 2. Recommendations # 1 and #2

Final Report Approved February 7, 2014

CONNECTICUT EMERGENCY MEDICAL SERVICES 3

Events Leading Up to the Creation of the Task Force

Task Force Composition

PSA System Analysis

Task Force Position Statements on Recommendation #5

Appendix A: Enabling Legislation