AS Title 18, Chapter 8: Emergency Medical Services

Chapter 08. Emergency Medical Services. Sec. 18.08.010. Administration. The department is responsible for the development, implementation, and maintenance of a statewide comprehensive emergency medical services system and, accordingly, shall (1) coordinate public and private agencies engaged in the planning and delivery of emergency medical services, including trauma care, to plan an emergency medical services system; (2) assist public and private agencies to deliver emergency medical services, including trauma care, through the award of grants in aid; (3) conduct, encourage, and approve programs of education and training designed to upgrade the knowledge and skills of health personnel involved in emergency medical services, including trauma care; (4) establish and maintain a process under which hospitals and clinics could represent themselves to be trauma centers because they voluntarily meet criteria adopted by the department; criteria adopted by the department to implement this paragraph must be based on an applicable national evaluation system. Sec. 18.08.015. Patient information system. (a) The department may establish an emergency medical services patient care information system. If the department collects information on emergency medical services patient care, the department shall establish a format for the data collection. The purpose of the system is to (1) collect data on the incidence, severity, and causes of trauma injuries; (2) integrate this data on trauma injuries with information available from other public and private sources on trauma injuries; and (3) improve the delivery of prehospital and hospital emergency medical services. (b) A person, organization, or government agency that provides a prehospital emergency medical service through a certificate issued under this chapter shall participate in the system by making available to the department the minimum data requested in a format that is compatible with the format developed by the department to implement (a) of this section. The minimum data must include the (1) type of medical emergency or nature of the call; (2) response time; and (3) prehospital treatment provided. (c) A hospital that provides emergency medical services shall make available to the department an abstract of the records of all patients admitted to the hospital's trauma and general surgery services for trauma care. The abstracts must be in a format that is compatible with the format developed by the department under (a) of this section. (d) [Repealed, E.O. No. 125, § 5 (2024).] (e) The department may delegate the responsibility for collecting data under this section to other public agencies or to private persons on contract to the department. (f) In this section, “system” means the emergency medical services patient care information system established under this section. Sec. 18.08.020. Alaska Council on Emergency Medical Services. Sec. 18.08.025. Statewide emergency medical services system. The commissioner shall advise the governor with regard to the planning and implementation of a statewide emergency medical services system. §§ 18.08.030 — 18.08.060. Composition; term of office; compensation and per diem; meetings. [Repealed, E.O. No. 125 § 5 (2024).] Sec. 18.08.070. Special committees. The commissioner may create special committees or task forces and may appoint persons who are not employees of the department to serve as advisors or consultants to any committee created to carry out the purposes of this chapter. Sec. 18.08.075. Authority of emergency medical technician and mobile intensive care paramedic. (a) An emergency medical technician or mobile intensive care paramedic who responds to an emergency with an ambulance service or first responder service, who has in the technician's or mobile intensive care paramedic's possession a current emergency medical technician or mobile intensive care paramedic identification card, and who provides emergency medical care or other emergency medical service, has the authority to (1) control and direct activities at the accident site or emergency until the arrival of law enforcement personnel; (2) order a person other than the owner to leave a building or place in the vicinity of the accident or other emergency for the purpose of protecting the person from injury; (3) temporarily block a public highway, street, or private right-of-way while at the scene of an accident, illness, or emergency; (4) trespass upon property at or near the scene of an accident, illness, or emergency at any time of day or night; (5) enter a building, including a private dwelling, or premises where a report of an injury or illness has taken place or where there is a reasonable cause to believe an individual has been injured or is ill to render emergency medical care; and (6) direct the removal or destruction of a motor vehicle or other thing that the emergency medical technician or mobile intensive care paramedic determines is necessary to prevent further harm to injured or ill individuals. (b) A person who knowingly refuses to comply with an order of an emergency medical technician or mobile intensive care paramedic authorized under (a) of this section is, upon conviction, guilty of a class B misdemeanor. In this subsection, “knowingly” has the meaning given in AS 11.81.900 (a). Sec. 18.08.080. Regulations. (a) The department shall adopt, with the concurrence of the Department of Public Safety, regulations establishing standards and procedures for the issuance, renewal, reissuance, revocation, and suspension of certificates or licenses required under AS 18.08.084 , as well as other regulations necessary to carry out the purposes of this chapter. (b) The department may charge fees set by regulation for the certification or licensure of individuals and organizations under this chapter. Sec. 18.08.082. Issuance of certificates and licenses; designations. (a) The department shall prescribe by regulation a course of training or other requirements prerequisite to the issuance of certificates or licenses that provide for the following: (1) certification of a person who meets the training and other requirements as an emergency medical technician, emergency medical technician instructor, or emergency medical dispatcher; (2) authorization for an emergency medical technician certified under this chapter to provide under the written or oral direction of a physician the advanced life support services enumerated on the certificate or enumerated on a written document filed with the department by the technician's medical director and approved by the department under its regulations; (3) certification that a person, organization, or government agency that provides an emergency medical service, conducts a training course for a mobile intensive care paramedic, or represents itself as a trauma center meets the minimum standards prescribed by the department for that service, course, or designation; (4) authorization for an emergency medical service certified under this chapter to provide under the written or oral direction of a physician the advanced life support services enumerated on the certificate or enumerated on a written document filed with the department by the medical director for the emergency medical service and approved by the department under its regulations; and (5) licensure of a mobile intensive care paramedic and the medical services that a mobile intensive care paramedic may perform, including the (A) educational and other qualifications, which may include education in pain management and opioid use and addiction; (B) application and licensing procedures; (C) scope of activities authorized; and (D) responsibilities of a supervising or training physician. (b) The department is the central certifying and licensing agency for a person, organization, or governmental agency that is certified or licensed under (a) of this section and under regulations adopted under AS 18.08.080 . (c) The commissioner shall establish special designations in regulation for varying levels of trauma care provided by any certified trauma center in the state that shall be used to set compensation eligibility and amounts under AS 18.08.085 . The designations shall be based on nationally recognized standards and procedures. Sec. 18.08.084. Certificate required. (a) One may not represent oneself, nor may an agency or business represent an agent or employee of that agency or business, as an emergency medical dispatcher, emergency medical technician, mobile intensive care paramedic, or emergency medical technician instructor certified or licensed by the state unless the person represented is certified or licensed for that occupation under AS 18.08.082 . (b) A person, organization, or government agency may not represent itself as an emergency medical service or ambulance service certified by the state unless the person, organization, or government agency is certified as an emergency medical service under AS 18.08.082 . (c) A person may not provide, offer, or advertise to provide advanced life support services outside a hospital unless authorized by law. (d) A person, organization, or government agency that provides, offers, or advertises to provide an emergency medical service may not provide advanced life support services unless authorized under AS 18.08.082 . (e) A hospital, clinic, or other entity may not represent itself as being a trauma center unless it is certified under AS 18.08.082 as meeting the criteria established for a trauma center. (f) A person, organization, or government agency may not offer or conduct a training course that is represented as a course for mobile intensive care paramedics unless the person, organization, or agency is certified under AS 18.08.082 to offer or conduct that course. Sec. 18.08.085. Trauma care fund; creation. (a) The trauma care fund is created. The purpose of the fund is to compensate certified trauma centers in the state that receive a special designation under AS 18.08.082 (c) and that achieve or maintain the highest appropriate level of trauma care designation. (b) The fund consists of money appropriated to it by the legislature, including donations, recoveries of or reimbursements for awards made from the fund, income from the fund, and other program receipts from activities under this chapter. Appropriations to the fund do not lapse. (c) The commissioner shall administer the fund in accordance with the provisions of this chapter. The commissioner shall spend money from the trauma care fund for the purpose established in (a) of this section. (d) The commissioner shall establish compensation standards under this section. The standards must include funding priorities for trauma centers receiving a special designation under AS 18.08.082 (c). The commissioner may seek the advice of a special committee for review of statewide trauma care and compensation standards. (e) The commissioner may not provide more than 25 percent of the total assets, including earnings, of the fund in a fiscal year to one trauma center. Sec. 18.08.086. Immunity from liability. (a) A person certified or licensed under AS 18.08.082 who administers emergency medical services to an injured or sick person, a person or public agency that employs, sponsors, directs, or controls the activities of persons certified or licensed under AS 18.08.082 who administer emergency medical services to an injured or sick person, or a health care professional or emergency medical dispatcher acting within the scope of the person's certification or licensure who directs or advises a person to administer emergency medical services to an injured or sick person is not liable for civil damages as a result of an act or omission in administering those services or giving that advice or those directions if the administering, advising, and directing are done in good faith and the injured or sick person reasonably seems to be in immediate danger of serious harm or death. This subsection does not preclude liability for civil damages that are the proximate result of gross negligence or intentional misconduct, nor preclude imposition of liability on a person or public agency that employs, sponsors, directs, or controls the activities of persons certified or licensed under AS 18.08.082 if the act or omission is a proximate result of a breach of duty to act created under this chapter. In this subsection, “gross negligence” means reckless, wilful, or wanton misconduct. (b) A physician who in good faith arranges for, requests, recommends, or initiates the transfer of a patient from a hospital to another hospital is not liable for civil damages as a result of arranging, requesting, recommending, or initiating the transfer if (1) in the exercise of that degree of knowledge or skill possessed, or that degree of care ordinarily exercised by physicians practicing the same specialty in the same or similar communities to that in which the physician is practicing, the physician determines that treatment of the patient's medical condition is beyond the capability of the transferring hospital or the medical community in which the hospital is located; (2) the physician has confirmed that the receiving facility is more capable of treating the patient; and (3) the physician has secured a prior agreement from the receiving facility to accept and render the necessary treatment to the patient. (c) A registered or advanced practice registered nurse or licensed practical nurse who escorts a patient in a means of conveyance not equipped as an ambulance is not liable for civil damages as a result of an act or omission in administering patient care services, if done in good faith and if the life of the injured or sick person is in danger. This subsection does not preclude liability for civil damages that are the result of gross negligence or intentional misconduct. (d) A person certified as an emergency medical technician instructor, a person or entity certified to conduct a training course for mobile intensive care paramedics, and a person who employs or contracts with a certified emergency medical technician instructor or with a person or entity certified to conduct a training course for mobile intensive care paramedics is not liable for civil damages as a result of a negligent act or omission during a training course that injures the person or property of a person participating in the training course. Sec. 18.08.087. Disclosure of medical records. When requested for the purpose of evaluating the performance of an emergency medical technician, mobile intensive care paramedic, or physician who provided emergency medical care or other assistance to a sick or injured person, a licensed physician, advanced practice registered nurse, or physician assistant may disclose to an emergency medical technician, a mobile intensive care paramedic, or physician the medical or hospital records of a sick or injured person to whom the paramedic, technician, or physician is providing or has rendered emergency medical care or assistance. However, the disclosing physician, advanced practice registered nurse, or physician assistant shall limit disclosure under this section to the records that are considered necessary by the discloser for evaluation of the paramedic's, technician's, or physician's performance in providing the emergency medical care or assistance. A mobile intensive care paramedic, emergency medical care technician, or physician to whom confidential records are disclosed under this section may not further disclose the information to a person not entitled to receive that information under this section or another law. Sec. 18.08.088. Penalty. A person who violates a provision of this chapter is guilty of a misdemeanor and upon conviction is punishable by a fine of not more than $1,000, or by imprisonment for not more than 90 days, or by both. Each violation is a separate offense. Sec. 18.08.089. Authority to pronounce death. (a) A mobile intensive care paramedic licensed under this chapter, a physician assistant registered or licensed under AS 08.64.107 , or an emergency medical technician certified under this chapter may make a determination and pronouncement of death of a person under the following circumstances: (1) the mobile intensive care paramedic or emergency medical technician is an active member of an emergency medical service certified under this chapter; (2) neither a physician licensed under AS 08.64 nor a physician exempt from licensure under AS 08.64 is immediately available for consultation by radio or telephone communications; (3) the mobile intensive care paramedic, physician assistant, or emergency medical technician has determined, based on acceptable medical standards, that the person has sustained irreversible cessation of circulatory and respiratory functions. (b) A mobile intensive care paramedic, physician assistant, or emergency medical technician who has determined and pronounced death under this section shall document the clinical criteria for the determination and pronouncement on the person's emergency medical service report form and notify the appropriate medical director or collaborative physician as soon as communication can be established. The paramedic, physician assistant, or emergency medical technician shall provide to the person who signs the death certificate the (1) name of the deceased; (2) presence of a contagious disease, if known; and (3) date and time of death. (c) Except as otherwise provided under AS 18.50.230 , a physician licensed under AS 08.64 shall certify a death determined under (b) of this section within 24 hours after the pronouncement by the mobile intensive care paramedic, physician assistant, or emergency medical technician. (d) In this section, (1) “acceptable medical standards” means cardiac arrest accompanied by (A) the presence of injuries incompatible with life, including incineration, decapitation, open head injury with loss of brain matter, or detruncation; (B) the presence of rigor mortis; (C) the presence of post mortem lividity; or (D) failure of the patient to respond to properly administered resuscitation efforts; (2) “failure of the patient to respond” means without restoration of spontaneous pulse or respiratory effort by the patient; (3) “properly administered resuscitation efforts” means (A) when a person authorized to perform advanced cardiac life support techniques is not available and the patient is not hypothermic, at least 30 minutes of properly performed cardiopulmonary resuscitation; (B) when a person authorized to perform advanced cardiac life support techniques is not available and the patient is hypothermic, at least 60 minutes of cardiopulmonary resuscitation properly performed in conjunction with rewarming techniques as described in the current cold injuries guidelines published by the Department of Health; or (C) at least 30 minutes of cardiopulmonary resuscitation and advanced cardiac life support techniques properly performed by a person authorized to perform advanced life support services. Sec. 18.08.090. [Renumbered as AS 18.08.200 .] Sec. 18.08.095. Air ambulance service. An air ambulance service provider that provides air ambulance services to an individual covered under an air ambulance membership agreement with the provider may not deny emergency medical services to any person on the basis that the person is not covered under an air ambulance membership agreement. In this section, “air ambulance membership agreement” and “air ambulance service provider” have the meanings given in AS 21.61.110 . Sec. 18.08.100. Telehealth. (a) An individual certified or licensed under this chapter may practice within the individual's authorized scope of practice under this chapter through telehealth with a patient in this state if the individual's certification or license is in good standing. (b) If an individual certified or licensed under this chapter determines in the course of a telehealth encounter with a patient that some or all of the encounter will extend beyond the individual's authorized scope of practice, the individual shall advise the patient that the individual is not authorized to provide some or all of the services to the patient, recommend that the patient contact an appropriate provider for the services the individual is not authorized to provide, and limit the encounter to only those services the individual is authorized to provide. The individual certified or licensed under this chapter may not charge for any portion of an encounter that extends beyond the individual's authorized scope of practice. (c) A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not exceed the fee typically charged for that service. (d) An individual certified or licensed under this chapter may not be required to document a barrier to an in-person visit to provide health care services through telehealth. The department may not limit the physical setting from which an individual certified or licensed under this chapter may provide health care services through telehealth. (e) Nothing in this section requires the use of telehealth when an individual certified or licensed under this chapter determines that providing services through telehealth is not appropriate or when a patient chooses not to receive services through telehealth. (f) In this section, “telehealth” has the meaning given in AS 47.05.270 (e). Sec. 18.08.200. Definitions. In this chapter, (1) “advanced life support” means emergency care techniques provided under the written or oral orders of a physician that include manual electric cardiac defibrillation, administration of antiarrhythmic agents, intravenous therapy, intramuscular therapy, or use of endotracheal intubation devices; (2) “ambulance” means any publicly or privately owned means of conveyance intended to be used and maintained or operated for the transportation of persons who are sick, injured, wounded, or otherwise helpless; (3) “commissioner” means the commissioner of health; (4) “consumer of emergency medical services” means a person who is not a provider of emergency medical services as defined in this section; (5) “department” means the Department of Health; (6) “emergency medical care” means the services utilized in responding to the perceived individual needs for immediate medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury; (7) “emergency medical dispatcher” means a trained public safety telecommunicator with additional training and specific emergency medical knowledge essential for the efficient management of emergency medical communications; (8) “emergency medical service” means the provision of emergency medical care and transportation of the sick and injured; (9) “emergency medical services system” means a system that provides for the arrangement of personnel, facilities, and equipment for the effective and coordinated delivery of health care services, including trauma care, under emergency conditions, occurring either as a result of the patient's condition or of natural disasters or similar situations, and that is administered by a statewide network that has the authority and resources to provide effective administration of the system; (10) “emergency medical technician” means a person trained in emergency medical care and certified in accordance with the regulations prescribed under AS 18.08.080 ; (11) “mobile intensive care paramedic” means an individual licensed by the department who has completed a paramedic training program approved by the department and is authorized by law to provide advanced life support under the direct or indirect supervision of a physician; (12) “paramedic training program” means a training program prescribed in regulations of the department that includes classroom, clinical, and field internship components designed to provide an individual with the knowledge and skills necessary to function as a mobile intensive care paramedic; (13) “provider of emergency medical services” means a person whose occupation or profession is, or has been, the delivery or administration of emergency medical services; a person who has a fiduciary position with, or has a fiduciary interest in, a health activity, facility or other health agency, or a legal or financial interest in the rendering of any component of emergency medical services; and (14) “trauma care” includes injury prevention, triage, prehospital care, hospital care, and rehabilitative services for major single system or multisystem injuries that require immediate medical or surgical intervention or treatment to prevent death or permanent disability.