Amd §122-b, Gen Muni L; amd §§3000, 3001 & 3020, add §§3019 & 3019-a, Pub Health L
Relates to emergency medical services; establishes a special district for the financing and operation of general ambulance services; provides for a statewide comprehensive emergency medical system plan.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A3392C
SPONSOR: Otis TITLE OF BILL:
An act to amend the general municipal law and the public health law, in
relation to emergency medical services
PURPOSE OR GENERAL IDEA OF BILL:
To deem emergency medical services as an essential service; to provide
municipalities with the flexibility to ensure provision of emergency
medical services; to establish statewide, regional, and county coordi-
nation of emergency medical services; and to provide for enhanced train-
ing and credentialing of emergency medical service practitioners, agen-
cies, and educational institutions.
SUMMARY OF PROVISIONS:
Section 1 amends the opening paragraph of subdivision 1 of section 122-b
of the general municipal law to declare that general ambulance services
are an essential service; requires that every county, city, town, and
village, acting individually or jointly, or in conjunction with a
special district, ensure that emergency medical service, general ambu-
lance service or a combination of such services are provided for;
exempts cities with a population of one million or more from the
requirements. This section also adds a new paragraph (g) to subdivision
1 of section 122-b to allow a county, city, town, or village, acting
individually, or jointly with any other county, city, town and/or
village, to establish a special district for the financing and operation
of general ambulance services by following the procedures in town law as
are required for establishment of fire districts.
Section 2 amends section 3000 of the public health law to clarify that
emergency medical services and ambulance services are essential services
that must be available to every person in the state in a reliable
manner.
Section 3 amends section 3001 of the public health law to expand the
definition of emergency medical services.
Section 4 creates a new section 3019 of the public health law providing
that the state emergency medical services council, in collaboration with
the department of health, shall develop and maintain a statewide compre-
hensive emergency medical system plan to improve coordination, accessi-
bility, and delivery of services, coordinate development of alternative
delivery models, and conduct and promote education and training of emer-
gency medical service practitioners; that regional emergency medical
services councils develop and maintain regional comprehensive emergency
medical system plans; and that counties develop and maintain comprehen-
sive county emergency medical system plans.
Section 5 creates a new section 3019-a of the public health law estab-
lishing the emergency medical systems training program, and provides
that the state emergency medical services council shall make recommenda-
tions to the department of health for the implementation of standards
related to the establishment of emergency medical systems training
programs, curricula, and requirements for emergency medical system
educational institutions. This section further provides that the depart-
ment of health shall ensure compliance with such standards.
Section 6 amends section 3020 of the public health law to provide for
the creation or adoption of additional standards, training, and criteria
to become an emergency medical service practitioner credentialled to
provide specialized, advanced, or other services, and for emergency
medical service agencies to become accredited in specific areas to
increase system performance.
Section 7 sets forth the effective date.
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):
This amendment adds provisions to ensure that communication, coordi-
nation, and planning take place among counties and other municipalities
when new special districts are created or existing districts dissolved
and when service changes are contemplated; to ensure inclusion of
current EMS providers in county and regional planning; and to require
notice to the department of health when permanent changes are proposed
to county or regional emergency medical system plans.
JUSTIFICATION:
New Yorkers expect emergency medical services (EMS) to be available at
all times and in all locations should they need assistance. These
services are essential, providing a wide range of prehospital medical
care to sick or injured people in emergency situations, and are often a
matter of life and death. EMS is a vital resource, necessary to the
health and well-being of communities across New York.
Despite the vast importance of EMS, there is an ongoing crisis in this
state, particularly in how EMS is funded, staffed, and operated. Much of
this stems from a fundamental misconception about EMS vis-a-vis other
critical services like police and fire. This is reflected in New York
State law, which currently fails to recognize the essential nature of
EMS. As a result, the work of EMS providers is undervalued within our
emergency and health care systems compared to other critical public
services, creating a disparity between the immense value that EMS work-
ers and volunteers provide to our communities and the resources made
available to provide these services. Accordingly, many EMS providers
across the state struggle to find and retain staff.
EMS providers are multi-faceted, highly-trained public servants who not
only provide ambulance services for New Yorkers in times of medical
emergency, but also pre-hospital care and general emergency response for
those who are injured, sick, or in need of immediate help. It is time
that New York law reflects the enormous sacrifices and critical work of
the EMS community.
Under the existing framework for the provision of EMS in New York,
private, public, and not-for-profit providers serve needs across the
state in a scattered, patchwork approach. This leaves many New York
residents uncertain whether an EMS provider will be available in their
locality in a time of need.
Creating greater flexibility for municipalities to facilitate EMS to
meet unique local challenges represents a critical next step in the
provision of these much needed services.
With that in mind, this bill amends the general municipal law to declare
general ambulance service to be an "essential service" and requires that
every county, city, town and village, acting individually or jointly, or
in conjunction with a special district, ensure that an emergency medical
service, a general ambulance service, or a combination of such services
is provided for. The bill allows any county, city, town, or village,
acting individually or jointly with any other county, city, town, or
village, to establish a special district for the financing and operation
of general ambulance services. The bill exempts any city with a popu-
lation of one million or more from this requirement.
Additionally, the bill provides for coordination of emergency medical
services on a statewide, regional, and countywide basis, and enhances
education and training programs for emergency medical service providers
and training institutions.
This bill takes necessary steps to recognize EMS as an essential service
that must be provided in every area of the state.
PRIOR LEGISLATIVE HISTORY:
S4020A / A3392A (2023): Referred to Local Government
S8432A/ A9509A (2021-22): Referred to Local Government
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Minimal fiscal impact to the state.
EFFECTIVE DATE:
This act shall take effect six months after it shall have become a law.
STATE OF NEW YORK
________________________________________________________________________
3392--C
2023-2024 Regular Sessions
IN ASSEMBLY
February 2, 2023
___________
Introduced by M. of A. OTIS, BUTTENSCHON, CLARK, LUPARDO, SANTABARBARA,
EACHUS, LEVENBERG, SILLITTI, KELLES, BENDETT, LUNSFORD, MCGOWAN,
BURDICK, MAHER, SIMPSON, ANGELINO, NORRIS, SHIMSKY, GUNTHER, FAHY,
BARRETT, McDONALD, J. M. GIGLIO, BLUMENCRANZ, FLOOD, DeSTEFANO -- read
once and referred to the Committee on Local Governments -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- recommitted to the Committee on Local Governments
in accordance with Assembly Rule 3, sec. 2 -- again reported from said
committee with amendments, ordered reprinted as amended and recommit-
ted to said committee -- again reported from said committee with
amendments, ordered reprinted as amended and recommitted to said
committee
AN ACT to amend the general municipal law and the public health law, in
relation to emergency medical services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The opening paragraph of subdivision 1 of section 122-b of
2 the general municipal law, as amended by chapter 471 of the laws of
3 2011, is amended and a new paragraph (g) is added to read as follows:
4 [Any] General ambulance services are an essential service. Every
5 county, city, town [or] and village, acting individually or jointly or
6 in conjunction with a special district, [may provide] shall ensure that
7 an emergency medical service, a general ambulance service or a combina-
8 tion of such services are provided for the purpose of providing prehos-
9 pital emergency medical treatment or transporting sick or injured
10 persons found within the boundaries of the municipality or the munici-
11 palities acting jointly to a hospital, clinic, sanatorium or other place
12 for treatment of such illness or injury, [and for] provided, however,
13 that the provisions of this subdivision shall not apply to a city with a
14 population of one million or more. In furtherance of that purpose, a
15 county, city, town or village may:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05007-13-4
A. 3392--C 2
1 (g) Establish a special district for the financing and operation of
2 general ambulance services, including support for agencies currently
3 providing EMS services, as set forth by this section, whereby any coun-
4 ty, city, town or village, acting individually, or jointly with any
5 other county, city, town and/or village, through its governing body or
6 bodies, following applicable procedures as are required for the estab-
7 lishment of fire districts in article eleven of the town law or follow-
8 ing applicable procedures as are required for the establishment of joint
9 fire districts in article eleven-A of the town law, with such special
10 district being authorized by this section to be established in all or
11 any part of any such participating county or counties, town or towns,
12 city or cities and/or village or villages. Notwithstanding any
13 provision of this article, rule or regulation to the contrary, any
14 special district created under this section shall not overlap with a
15 pre-existing city, town or village ambulance district unless such exist-
16 ing district is merged into the newly created district. No city, town
17 or village shall eliminate or dissolve a pre-existing ambulance district
18 without express approval and consent by the county to assume responsi-
19 bility for the emergency medical services previously provided by such
20 district. When a special district is established pursuant to this arti-
21 cle, the cities, towns, or villages contained within the county shall
22 not reduce current ambulance funding without such changes being incorpo-
23 rated into the comprehensive county emergency medical system plan.
24 § 2. Section 3000 of the public health law, as amended by chapter 804
25 of the laws of 1992, is amended to read as follows:
26 § 3000. Declaration of policy and statement of purpose. The furnishing
27 of medical assistance in an emergency is a matter of vital concern
28 affecting the public health, safety and welfare. Emergency medical
29 services and ambulance services are essential services and shall be
30 available to every person in the state of New York in a reliable manner.
31 Prehospital emergency medical care, other emergency medical services,
32 the provision of prompt and effective communication among ambulances and
33 hospitals and safe and effective care and transportation of the sick and
34 injured are essential public health services and shall be available to
35 every person in the state of New York in a reliable manner.
36 It is the purpose of this article to promote the public health, safety
37 and welfare by providing for certification of all advanced life support
38 first response services and ambulance services; the creation of regional
39 emergency medical services councils; and a New York state emergency
40 medical services council to develop minimum training standards for
41 certified first responders, emergency medical technicians and advanced
42 emergency medical technicians and minimum equipment and communication
43 standards for advanced life support first response services and ambu-
44 lance services.
45 § 3. Subdivision 1 of section 3001 of the public health law, as
46 amended by chapter 804 of the laws of 1992, is amended to read as
47 follows:
48 1. "Emergency medical service" means [initial emergency medical
49 assistance including, but not limited to, the treatment of trauma,
50 burns, respiratory, circulatory and obstetrical emergencies] a coordi-
51 nated system of healthcare delivery that responds to the needs of sick
52 and injured adults and children, by providing: essential care at the
53 scene of an emergency, non-emergency, specialty need or public event;
54 community education and prevention programs; ground and air ambulance
55 services; centralized access and emergency medical dispatch; training
56 for emergency medical services practitioners; medical first response;
A. 3392--C 3
1 mobile trauma care systems; mass casualty management; medical direction;
2 or quality control and system evaluation procedures.
3 § 4. The public health law is amended by adding a new section 3019 to
4 read as follows:
5 § 3019. Statewide comprehensive emergency medical system plan. 1. The
6 state emergency medical services council, in collaboration and with
7 final approval of the department, shall develop and maintain a statewide
8 comprehensive emergency medical system plan that shall provide for a
9 coordinated emergency medical system within the state, which shall
10 include but not be limited to:
11 (a) establishing a comprehensive statewide emergency medical system,
12 consisting of facilities, transportation, workforce, communications, and
13 other components to improve the delivery of emergency medical service
14 and thereby decrease morbidity, hospitalization, disability, and mortal-
15 ity;
16 (b) improving the accessibility of high-quality emergency medical
17 service;
18 (c) coordinating professional medical organizations, hospitals, and
19 other public and private agencies in developing alternative delivery
20 models for persons who are presently using emergency departments for
21 routine, nonurgent and primary medical care to be served appropriately
22 and economically, provided, however, that the provisions of this subdi-
23 vision shall not apply to a city with a population of one million or
24 more; and
25 (d) conducting, promoting, and encouraging programs of education and
26 training designed to upgrade the knowledge and skills of emergency
27 medical service practitioners throughout the state with emphasis on
28 regions underserved by or with limited access to emergency medical
29 services.
30 2. The statewide comprehensive emergency medical system plan shall be
31 reviewed, updated if necessary, and published every five years on the
32 department's website, or at such earlier times as may be necessary to
33 improve the effectiveness and efficiency of the state's emergency
34 medical service system.
35 3. Each regional emergency medical services council shall develop and
36 maintain a comprehensive regional emergency medical system plan or adopt
37 the statewide comprehensive emergency medical service system plan, to
38 provide for a coordinated emergency medical system within the region.
39 Such plans shall incorporate all ambulance services with a current EMS
40 operating certificate for response to calls in their designated operat-
41 ing territory and shall be subject to review by the state emergency
42 medical services council and final approval by the department. Any
43 proposed permanent changes to the regional emergency medical system
44 plan, including the dissolution of an ambulance services district or
45 other significant modification of existing coverage shall be submitted
46 in writing to the department no later than one hundred eighty days
47 before the change shall take effect. Such changes shall not be made
48 until receipt of the appropriate departmental approvals.
49 4. Each county shall develop and maintain a comprehensive county emer-
50 gency medical system plan that shall provide for a coordinated emergency
51 medical system within the county, to provide essential emergency medical
52 services for all residents within the county. The county office of emer-
53 gency medical services shall be responsible for the development, imple-
54 mentation, and maintenance of the comprehensive county emergency medical
55 system plan. Such plans may require review and approval, as determined
56 by the state emergency medical services council, by such council, the
A. 3392--C 4
1 regional emergency medical services council and approval by the depart-
2 ment. Such plan shall incorporate all ambulance services with a current
3 EMS operating certificate for response to calls in their designated
4 operating territory and shall outline the primary responding agency for
5 requests for service for each part of the county. Any proposed perma-
6 nent changes to the county emergency medical system plan, including the
7 dissolution of an ambulance services district or other significant
8 modification of existing coverage shall be submitted in writing to the
9 department no later than one hundred eighty days before the change shall
10 take effect. Such changes shall not be made until receipt of the appro-
11 priate approvals. No county shall remove or reassign an area served by
12 an existing medical emergency response agency where such agency is
13 compliant with all statutory and regulatory requirements, and has agreed
14 to the provision of the approved plan.
15 § 5. The public health law is amended by adding a new section 3019-a
16 to read as follows:
17 § 3019-a. Emergency medical systems training program. 1. The state
18 emergency medical services council shall make recommendations to the
19 department for the department to implement standards related to the
20 establishment of training programs for emergency medical systems that
21 include but are not limited to students, emergency medical service prac-
22 titioners, emergency medical services agencies, approved educational
23 institutions, geographic areas, facilities, and personnel, and the
24 commissioner shall fund such training programs in full or in part based
25 on state appropriations. Until such time as the department announces
26 the training program established pursuant to this section is in effect,
27 all current standards, curricula, and requirements for students, emer-
28 gency medical service practitioners, agencies, facilities, and personnel
29 shall remain in effect.
30 2. The state emergency medical services council, with final approval
31 of the department, shall establish minimum education standards, curric-
32 ula, and requirements for all emergency medical system educational
33 institutions. No person or educational institution shall profess to
34 provide emergency medical system training without meeting the require-
35 ments set forth in regulation and only after approval of the department.
36 3. The department is authorized to provide, either directly or through
37 contract, for local or statewide initiatives, emergency medical system
38 training for emergency medical service practitioners and emergency
39 medical system agency personnel, using funding including but not limited
40 to allocations to aid to localities for emergency medical services
41 training.
42 4. Notwithstanding any other provisions of this section, the regional
43 emergency medical services council with jurisdiction over the city of
44 New York shall have authority to establish, subject to the approval of
45 the commissioner, training and educational requirements which shall
46 apply to all emergency medical practitioners working in the 911 system
47 of the city of New York and to determine protocols for the delivery of
48 emergency medical care, including those related to staffing, in the 911
49 system of the city of New York. Such training and educational require-
50 ments and protocols for the delivery of care shall be at least equal or
51 comparable to those applicable to emergency medical service practition-
52 ers in other areas of the state.
53 5. The department may visit and inspect any emergency medical system
54 training program or training center operating under this article to
55 ensure compliance. The department may request the state or regional
56 emergency medical services council's assistance to ensure the compli-
A. 3392--C 5
1 ance, maintenance, and coordination of training programs. Emergency
2 medical services institutions that fail to meet applicable standards and
3 regulations may be subject to enforcement action, including but not
4 limited to revocation, suspension, performance improvement plans, or
5 restriction from specific types of education.
6 § 6. Section 3020 of the public health law is amended by adding three
7 new subdivisions 3, 4 and 5 to read as follows:
8 3. The department, with the approval of the state emergency medical
9 services council, may create or adopt additional standards, training and
10 criteria to become an emergency medical service practitioner credent-
11 ialled to provide specialized, advanced, or other services that further
12 support or advance the emergency medical system. The department, with
13 approval of the state emergency medical services council may also set
14 standards and requirements to require specialized credentials to perform
15 certain functions in the emergency medical services system.
16 4. The department, with approval of the state emergency medical
17 services council may also set standards for emergency medical system
18 agencies to become accredited in a specific area to increase system
19 performance and agency recognition.
20 5. Notwithstanding any other provisions of this section, the regional
21 emergency medical services council with jurisdiction over the city of
22 New York shall have authority to establish, subject to the approval of
23 the commissioner, training and educational requirements which shall
24 apply to all emergency medical practitioners working in the 911 system
25 of the city of New York and to determine protocols for the delivery of
26 emergency medical care, including those related to staffing, in the 911
27 system of the city of New York. Such training and educational require-
28 ments and protocols for the delivery of care shall be at least equal or
29 comparable to those applicable to emergency medical service practition-
30 ers in other areas of the state.
31 § 7. This act shall take effect six months after it shall have become
32 a law.
