130th Ohio General Assembly
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S. B. No. 105  As Introduced
As Introduced

130th General Assembly
Regular Session
2013-2014
S. B. No. 105


Senator Kearney 

Cosponsors: Senators Lehner, Seitz 



A BILL
To amend sections 3701.74, 4723.481, 4723.50, 4730.39, 4730.40, 4730.43, 4765.11, 4765.16, 4765.35, and 4765.37 and to enact sections 3701.138, 3709.42, 4723.488, 4729.282, 4730.431, 4731.94, and 4765.161 of the Revised Code concerning the availability of naloxone.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1.  That sections 3701.74, 4723.481, 4723.50, 4730.39, 4730.40, 4730.43, 4765.11, 4765.16, 4765.35, and 4765.37 be amended and sections 3701.138, 3709.42, 4723.488, 4729.282, 4730.431, 4731.94, and 4765.161 of the Revised Code be enacted to read as follows:
Sec. 3701.138.  (A) The director of health shall adopt rules in accordance with Chapter 119. of the Revised Code to do both of the following:
(1) Specify what constitutes the training necessary for an individual who is not authorized by the Revised Code to administer naloxone to safely and properly administer that drug to another individual by the intranasal route of administration.
(2) Create a certificate to be issued to each individual who successfully completes intranasal naloxone administration training.
(B) The department of health shall create and maintain a list of individuals who have received naloxone training certificates.
The department shall make the names on the list available on request to boards of health of city and general health districts and authorities having the duties of a board of health as authorized by section 3709.05 of the Revised Code and to individuals who are authorized by the Revised Code to prescribe, furnish, or dispense naloxone.
The identity of an individual who has received a naloxone training certificate is a "medical record" under section 149.43 of the Revised Code.
Sec. 3701.74.  (A) As used in this section and section 3701.741 of the Revised Code:
(1) "Ambulatory care facility" means a facility that provides medical, diagnostic, or surgical treatment to patients who do not require hospitalization, including a dialysis center, ambulatory surgical facility, cardiac catheterization facility, diagnostic imaging center, extracorporeal shock wave lithotripsy center, home health agency, inpatient hospice, birthing center, radiation therapy center, emergency facility, and an urgent care center. "Ambulatory care facility" does not include the private office of a physician or dentist, whether the office is for an individual or group practice.
(2) "Chiropractor" means an individual licensed under Chapter 4734. of the Revised Code to practice chiropractic.
(3) "Emergency facility" means a hospital emergency department or any other facility that provides emergency medical services.
(4) "Health care practitioner" means all of the following:
(a) A dentist or dental hygienist licensed under Chapter 4715. of the Revised Code;
(b) A registered or licensed practical nurse licensed under Chapter 4723. of the Revised Code;
(c) An optometrist licensed under Chapter 4725. of the Revised Code;
(d) A dispensing optician, spectacle dispensing optician, contact lens dispensing optician, or spectacle-contact lens dispensing optician licensed under Chapter 4725. of the Revised Code;
(e) A pharmacist licensed under Chapter 4729. of the Revised Code;
(f) A physician;
(g) A physician assistant authorized under Chapter 4730. of the Revised Code to practice as a physician assistant;
(h) A practitioner of a limited branch of medicine issued a certificate under Chapter 4731. of the Revised Code;
(i) A psychologist licensed under Chapter 4732. of the Revised Code;
(j) A chiropractor;
(k) A hearing aid dealer or fitter licensed under Chapter 4747. of the Revised Code;
(l) A speech-language pathologist or audiologist licensed under Chapter 4753. of the Revised Code;
(m) An occupational therapist or occupational therapy assistant licensed under Chapter 4755. of the Revised Code;
(n) A physical therapist or physical therapy assistant licensed under Chapter 4755. of the Revised Code;
(o) A professional clinical counselor, professional counselor, social worker, or independent social worker licensed, or a social work assistant registered, under Chapter 4757. of the Revised Code;
(p) A dietitian licensed under Chapter 4759. of the Revised Code;
(q) A respiratory care professional licensed under Chapter 4761. of the Revised Code;
(r) An emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic certified under Chapter 4765. of the Revised Code.
(5) "Health care provider" means a hospital, ambulatory care facility, long-term care facility, pharmacy, emergency facility, or health care practitioner.
(6) "Hospital" has the same meaning as in section 3727.01 of the Revised Code.
(7) "Long-term care facility" means a nursing home, residential care facility, or home for the aging, as those terms are defined in section 3721.01 of the Revised Code; a residential facility licensed under section 5119.22 of the Revised Code that provides accommodations, supervision, and personal care services for three to sixteen unrelated adults; a nursing facility or intermediate care facility for the mentally retarded, as those terms are defined in section 5111.20 of the Revised Code; a facility or portion of a facility certified as a skilled nursing facility under Title XVIII of the "Social Security Act," 49 Stat. 286 (1965), 42 U.S.C.A. 1395, as amended.
(8) "Medical record" means data in any form that pertains to a patient's medical history, diagnosis, prognosis, or medical condition and that is generated and maintained by a health care provider in the process of the patient's health care treatment.
(9) "Medical records company" means a person who stores, locates, or copies medical records for a health care provider, or is compensated for doing so by a health care provider, and charges a fee for providing medical records to a patient or patient's representative.
(10) "Patient" means either any of the following:
(a) An individual who received health care treatment from a health care provider;
(b) A guardian, as defined in section 1337.11 of the Revised Code, of an individual described in division (A)(10)(a) of this section;
(c) An individual who seeks naloxone from a qualified health care provider for possible administration to another individual.
(11) "Patient's personal representative" means a minor patient's parent or other person acting in loco parentis, a court-appointed guardian, or a person with durable power of attorney for health care for a patient, the executor or administrator of the patient's estate, or the person responsible for the patient's estate if it is not to be probated. "Patient's personal representative" does not include an insurer authorized under Title XXXIX of the Revised Code to do the business of sickness and accident insurance in this state, a health insuring corporation holding a certificate of authority under Chapter 1751. of the Revised Code, or any other person not named in this division.
(12) "Pharmacy" has the same meaning as in section 4729.01 of the Revised Code.
(13) "Physician" means a person authorized under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery.
(14) "Authorized person" means a person to whom a patient has given written authorization to act on the patient's behalf regarding the patient's medical record.
(B) A patient, a patient's personal representative or an authorized person who wishes to examine or obtain a copy of part or all of a medical record shall submit to the health care provider a written request signed by the patient, personal representative, or authorized person dated not more than one year before the date on which it is submitted. The request shall indicate whether the copy is to be sent to the requestor, physician or chiropractor, or held for the requestor at the office of the health care provider. Within a reasonable time after receiving a request that meets the requirements of this division and includes sufficient information to identify the record requested, a health care provider that has the patient's medical records shall permit the patient to examine the record during regular business hours without charge or, on request, shall provide a copy of the record in accordance with section 3701.741 of the Revised Code, except that if a physician or chiropractor who has treated the patient determines for clearly stated treatment reasons that disclosure of the requested record is likely to have an adverse effect on the patient, the health care provider shall provide the record to a physician or chiropractor designated by the patient. The health care provider shall take reasonable steps to establish the identity of the person making the request to examine or obtain a copy of the patient's record.
(C) If a health care provider fails to furnish a medical record as required by division (B) of this section, the patient, personal representative, or authorized person who requested the record may bring a civil action to enforce the patient's right of access to the record.
(D)(1) This section does not apply to medical records whose release is covered by section 173.20 or 3721.13 of the Revised Code, by Chapter 1347. or 5122. of the Revised Code, by 42 C.F.R. part 2, "Confidentiality of Alcohol and Drug Abuse Patient Records," or by 42 C.F.R. 483.10.
(2) Nothing in this section is intended to supersede the confidentiality provisions of sections 2305.24, 2305.25, 2305.251, and 2305.252 of the Revised Code.
Sec. 3709.42.  The board of health of a city or general health district or the authority having the duties of a board of health as authorized by section 3709.05 of the Revised Code may establish a program to make intranasal naloxone available to individuals who are at risk of opioid overdose and individuals who have personal relationships with such individuals.
A board or authority that conducts an intranasal naloxone program shall provide for training, in accordance with rules adopted under section 3701.138 of the Revised Code, of individuals who receive intranasal naloxone on the basis of personal relationships with individuals who are at risk of opioid overdose. The training shall be provided either directly by the board or authority or by arrangement with another entity. The board or authority or the entity providing the training may charge an individual for training, intranasal naloxone, and supplies.
The board, authority, or entity providing naloxone administration training shall issue a certificate to each individual who successfully completes the training. The board or authority shall report the name of each such individual to the department of health for inclusion on the list maintained by the department under section 3701.138 of the Revised Code.
Sec. 4723.481.  This section establishes standards and conditions regarding the authority of a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner to prescribe drugs and therapeutic devices under a certificate to prescribe issued under section 4723.481 of the Revised Code.
(A) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner shall not prescribe any drug or therapeutic device that is not included in the types of drugs and devices listed on the formulary established in rules adopted under section 4723.50 of the Revised Code.
(B) The prescriptive authority of a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner shall not exceed the prescriptive authority of the collaborating physician or podiatrist, including the collaborating physician's authority to treat chronic pain with controlled substances and products containing tramadol as described in section 4731.052 of the Revised Code.
(C)(1) Except as provided in division (C)(2) or (3) of this section, a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner may prescribe to a patient a schedule II controlled substance only if all of the following are the case:
(a) The patient has a terminal condition, as defined in section 2133.01 of the Revised Code.
(b) The collaborating physician of the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner initially prescribed the substance for the patient.
(c) The prescription is for an amount that does not exceed the amount necessary for the patient's use in a single, twenty-four-hour period.
(2) The restrictions on prescriptive authority in division (C)(1) of this section do not apply if a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner issues the prescription to the patient from any of the following locations:
(a) A hospital registered under section 3701.07 of the Revised Code;
(b) An entity owned or controlled, in whole or in part, by a hospital or by an entity that owns or controls, in whole or in part, one or more hospitals;
(c) A health care facility operated by the department of mental health or the department of developmental disabilities;
(d) A nursing home licensed under section 3721.02 of the Revised Code or by a political subdivision certified under section 3721.09 of the Revised Code;
(e) A county home or district home operated under Chapter 5155. of the Revised Code that is certified under the medicare or medicaid program;
(f) A hospice care program, as defined in section 3712.01 of the Revised Code;
(g) A community mental health agency, as defined in section 5122.01 of the Revised Code;
(h) An ambulatory surgical facility, as defined in section 3702.30 of the Revised Code;
(i) A freestanding birthing center, as defined in section 3702.51 of the Revised Code;
(j) A federally qualified health center, as defined in section 3701.047 of the Revised Code;
(k) A federally qualified health center look-alike, as defined in section 3701.047 of the Revised Code;
(l) A health care office or facility operated by the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code;
(m) A site where a medical practice is operated, but only if the practice is comprised of one or more physicians who also are owners of the practice; the practice is organized to provide direct patient care; and the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner providing services at the site has a standard care arrangement and collaborates with at least one of the physician owners who practices primarily at that site.
(3) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner shall not issue to a patient a prescription for a schedule II controlled substance from a convenience care clinic even if the clinic is owned or operated by an entity specified in division (C)(2) of this section.
(D) A pharmacist who acts in good faith reliance on a prescription issued by a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner under division (C)(2) of this section is not liable for or subject to any of the following for relying on the prescription: damages in any civil action, prosecution in any criminal proceeding, or professional disciplinary action by the state board of pharmacy under Chapter 4729. of the Revised Code.
(E) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner may personally furnish to a patient a sample of any drug or therapeutic device included in the types of drugs and devices listed on the formulary, except that all of the following conditions apply:
(1) The amount of the sample furnished shall not exceed a seventy-two-hour supply, except when the minimum available quantity of the sample is packaged in an amount that is greater than a seventy-two-hour supply, in which case the packaged amount may be furnished.
(2) No charge may be imposed for the sample or for furnishing it.
(3) Samples of controlled substances may not be personally furnished.
(F) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner may personally furnish to a patient a complete or partial supply of a drug or therapeutic device included in the types of drugs and devices listed on the formulary, except that all of the following conditions apply:
(1) The clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner shall personally furnish only antibiotics, antifungals, scabicides, naloxone, contraceptives, prenatal vitamins, antihypertensives, drugs and devices used in the treatment of diabetes, drugs and devices used in the treatment of asthma, and drugs used in the treatment of dyslipidemia.
(2) The clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner shall not furnish the drugs and devices in locations other than a health department operated by the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code, a federally funded comprehensive primary care clinic, or a nonprofit health care clinic or program.
(3) The clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner shall comply with all safety standards for personally furnishing supplies of drugs and devices, as established in rules adopted under section 4723.50 of the Revised Code.
Sec. 4723.488.  (A) As used in this section, "APRN" means an advanced practice registered nurse who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner and holds a certificate to prescribe issued under section 4723.48 of the Revised Code.
(B) Notwithstanding any provision of this chapter or rule adopted by the board of nursing, an APRN may personally furnish intranasal naloxone, or issue a prescription for intranasal naloxone, without having examined the patient to whom it may be administered if all of the following conditions are met:
(1) The drug is furnished, or prescription issued to and in the name of, an individual who has a personal relationship with the patient and is seeking the naloxone for use in the event of opioid overdose by the patient;
(2) The individual to whom the drug is furnished or prescription issued presents a certificate of naloxone training issued under section 3709.42 of the Revised Code to the APRN.
Sec. 4723.50.  (A) In accordance with Chapter 119. of the Revised Code, the board of nursing shall adopt rules as necessary to implement the provisions of this chapter pertaining to the authority of clinical nurse specialists, certified nurse-midwives, and certified nurse practitioners to prescribe drugs and therapeutic devices and the issuance and renewal of certificates to prescribe.
The board shall adopt rules that are consistent with the recommendations the board receives from the committee on prescriptive governance pursuant to section 4723.492 of the Revised Code. After reviewing a recommendation submitted by the committee, the board may either adopt the recommendation as a rule or ask the committee to reconsider and resubmit the recommendation. The board shall not adopt any rule that does not conform to a recommendation made by the committee.
(B) The board shall adopt rules under this section that do all of the following:
(1) Establish a formulary listing the types of drugs and therapeutic devices that may be prescribed by a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner. The formulary may include controlled substances, as defined in section 3719.01 of the Revised Code and shall include naloxone. The formulary shall not permit the prescribing of any drug or device to perform or induce an abortion.
(2) Establish safety standards to be followed by a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner when personally furnishing to patients complete or partial supplies of antibiotics, antifungals, scabicides, naloxone contraceptives, prenatal vitamins, antihypertensives, drugs and devices used in the treatment of diabetes, drugs and devices used in the treatment of asthma, and drugs used in the treatment of dyslipidemia;
(3) Establish criteria for the components of the standard care arrangements described in section 4723.431 of the Revised Code that apply to the authority to prescribe, including the components that apply to the authority to prescribe schedule II controlled substances. The rules shall be consistent with that section and include all of the following:
(a) Quality assurance standards;
(b) Standards for periodic review by a collaborating physician or podiatrist of the records of patients treated by the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner;
(c) Acceptable travel time between the location at which the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner is engaging in the prescribing components of the nurse's practice and the location of the nurse's collaborating physician or podiatrist;
(d) Any other criteria recommended by the committee on prescriptive governance.
(4) Establish standards and procedures for issuance and renewal of a certificate to prescribe, including specification of any additional information the board may require under division (A)(4), (C)(7), or (D)(6) of section 4723.482 or division (B)(3) of section 4723.485 of the Revised Code;
(5) Establish standards for board approval of the course of study in advanced pharmacology and related topics required by section 4723.482 of the Revised Code;
(6) Establish requirements for board approval of the two-hour course of instruction in the laws of this state as required under division (C)(6) of section 4723.482 of the Revised Code and division (B)(2) of section 4723.484 of the Revised Code;
(7) Establish standards and procedures for the appropriate conduct of an externship as described in section 4723.484 of the Revised Code, including the following:
(a) Standards and procedures to be used in evaluating an individual's participation in an externship;
(b) Standards and procedures for the supervision that a physician must provide during an externship, including supervision provided by working with the participant and supervision provided by making timely reviews of the records of patients treated by the participant. The manner in which supervision must be provided may vary according to the location where the participant is practicing and with the participant's level of experience.
Sec. 4729.282.  As used in this section, "valid prescription" means a prescription authorized by section 4723.488, 4730.431, or 4731.94 of the Revised Code.
Notwithstanding any provision of this chapter or rule adopted by the state board of pharmacy, a pharmacist may fill a valid prescription for intranasal naloxone that is issued to an individual for the possible administration to another individual.
Sec. 4730.39.  (A) Not later than six months after receiving the initial recommendations of the physician assistant policy committee submitted pursuant to division (A) of section 4730.38 of the Revised Code, the state medical board shall adopt rules governing physician-delegated prescriptive authority for physician assistants, including the issuance of certificates to prescribe under this chapter. The board's rules shall establish all of the following:
(1) Subject to the limitations specified in section 4730.40 of the Revised Code, a formulary listing the drugs and therapeutic devices by class and specific generic nomenclature that a physician may include in the physician-delegated prescriptive authority granted to a physician assistant who holds a certificate to prescribe under this chapter;
(2) Requirements regarding the pharmacology courses that a physician assistant is required to complete to receive a certificate to prescribe;
(3) Standards and procedures for the issuance and renewal of certificates to prescribe to physician assistants;
(4) Standards and procedures for the appropriate conduct of the provisional period that a physician assistant is required to complete pursuant to section 4730.45 of the Revised Code and for determining whether a physician assistant has successfully completed the provisional period;
(5) A specific prohibition against prescribing any drug or device to perform or induce an abortion;
(6) Standards and procedures to be followed by a physician assistant in personally furnishing samples of drugs or complete or partial supplies of drugs to patients under section sections 4730.43 and 4730.431 of the Revised Code;
(7) Any other requirements the board considers necessary to implement the provisions of this chapter regarding physician-delegated prescriptive authority and the issuance of certificates to prescribe.
(B) After adopting the initial rules, the board shall conduct an annual review of the rules. Based on its review, the board shall make any necessary modifications to the rules.
(C) All rules adopted under this section shall be adopted in accordance with Chapter 119. of the Revised Code. When adopting the initial rules, the board shall consider the recommendations of the physician assistant policy committee submitted pursuant to division (A) of section 4730.38 of the Revised Code. When making any modifications to the rules subsequent to its annual review of the rules, the board shall consider the committee's recommendations submitted pursuant to division (B) of section 4730.38 of the Revised Code.
Sec. 4730.40.  (A) Subject to divisions (B) and (C) of this section, the formulary established by the state medical board in rules adopted under section 4730.39 of the Revised Code listing the drugs and therapeutic devices by class and specific nomenclature that a supervising physician may include in the physician-delegated prescriptive authority granted to a physician assistant who holds a certificate to prescribe issued under this chapter may include any or all of the following drugs:
(1) Schedule III, IV, and V controlled substances;
(2) Drugs that under state or federal law may be dispensed only pursuant to a prescription by a licensed health professional authorized to prescribe drugs, as defined in section 4729.01 of the Revised Code;
(3) Any drug that is not a dangerous drug, as defined in section 4729.01 of the Revised Code.
(B) The formulary established in the board's rules shall not include, and shall specify that it does not include, the following:
(1) Any schedule II controlled substance;
(2) Any drug or device used to perform or induce an abortion.
(C) The formulary shall include naloxone.
(D) When adopting rules establishing the initial formulary, the board shall include provisions ensuring that a physician assistant who holds a certificate to prescribe issued under this chapter may be granted physician-delegated prescriptive authority for all drugs and therapeutic devices that may be prescribed on the effective date of the rules by a holder of a certificate to prescribe issued by the board of nursing under Chapter 4723. of the Revised Code, with the exception of schedule II controlled substances. To the extent permitted by division (A) of this section, the initial formulary may include additional drugs or therapeutic devices.
Sec. 4730.43. (A) A physician assistant who holds a certificate to prescribe issued under this chapter and has been granted physician-delegated prescriptive authority by a supervising physician may personally furnish to a patient samples of drugs and therapeutic devices that are included in the physician assistant's physician-delegated prescriptive authority, subject to all of the following:
(1) The amount of the sample furnished shall not exceed a seventy-two-hour supply, except when the minimum available quantity of the sample is packaged in an amount that is greater than a seventy-two-hour supply, in which case the physician assistant may furnish the sample in the package amount.
(2) No charge may be imposed for the sample or for furnishing it.
(3) Samples of controlled substances may not be personally furnished.
(B) A physician assistant who holds a certificate to prescribe issued under this chapter and has been granted physician-delegated prescriptive authority by a supervising physician may personally furnish to a patient a complete or partial supply of the drugs and therapeutic devices that are included in the physician assistant's physician-delegated prescriptive authority, subject to all of the following:
(1) The physician assistant shall personally furnish only antibiotics, antifungals, scabicides, naloxone, contraceptives, prenatal vitamins, antihypertensives, drugs and devices used in the treatment of diabetes, drugs and devices used in the treatment of asthma, and drugs used in the treatment of dyslipidemia.
(2) The physician assistant shall not furnish the drugs and devices in locations other than a health department operated by the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code, a federally funded comprehensive primary care clinic, or a nonprofit health care clinic or program.
(3) The physician assistant shall comply with all standards and procedures for personally furnishing supplies of drugs and devices, as established in rules adopted under section 4730.39 of the Revised Code.
Sec. 4730.431.  Notwithstanding any provision of this chapter or rule adopted by the state medical board, a physician assistant who holds a certificate to prescribe issued under this chapter may personally furnish intranasal naloxone, or issue a prescription for intranasal naloxone, without having examined the patient to whom it may be administered if both of the following conditions are met:
(A) The drug is furnished, or prescription issued to and in the name of, an individual who has a personal relationship with the patient and is seeking the naloxone for use in the event of opioid overdose by the patient;
(B) The individual to whom the drug is furnished or prescription issued presents a certificate of naloxone training issued under section 3709.42 of the Revised Code to the physician assistant.
Sec. 4731.94.  As used in this section, "physician" means an individual authorized under this chapter to practice medicine and surgery or osteopathic medicine and surgery.
Notwithstanding any provision of this chapter or rule adopted by the state medical board, a physician may personally furnish intranasal naloxone, or issue a prescription for intranasal naloxone, without having examined the individual to whom it may be administered if all of the following conditions are met:
(A) The drug is furnished, or prescription issued to and in the name of, an individual who has a personal relationship with the patient and is seeking the intranasal naloxone for use in the event of opioid overdose by the patient;
(B) The individual to whom the drug is furnished or prescription issued presents a certificate of naloxone training issued under section 3709.42 of the Revised Code to the physician.
Sec. 4765.11.  (A) The state board of emergency medical services shall adopt, and may amend and rescind, rules in accordance with Chapter 119. of the Revised Code and division (C) of this section that establish all of the following:
(1) Procedures for its governance and the control of its actions and business affairs;
(2) Standards for the performance of emergency medical services by first responders, emergency medical technicians-basic, emergency medical technicians-intermediate, and emergency medical technicians-paramedic;
(3) Application fees for certificates of accreditation, certificates of approval, certificates to teach, and certificates to practice, which shall be deposited into the trauma and emergency medical services fund created in section 4513.263 of the Revised Code;
(4) Criteria for determining when the application or renewal fee for a certificate to practice may be waived because an applicant cannot afford to pay the fee;
(5) Procedures for issuance and renewal of certificates of accreditation, certificates of approval, certificates to teach, and certificates to practice, including any procedures necessary to ensure that adequate notice of renewal is provided in accordance with division (D) of section 4765.30 of the Revised Code;
(6) Procedures for suspending or revoking certificates of accreditation, certificates of approval, certificates to teach, and certificates to practice;
(7) Grounds for suspension or revocation of a certificate to practice issued under section 4765.30 of the Revised Code and for taking any other disciplinary action against a first responder, EMT-basic, EMT-I, or paramedic;
(8) Procedures for taking disciplinary action against a first responder, EMT-basic, EMT-I, or paramedic;
(9) Standards for certificates of accreditation and certificates of approval;
(10) Qualifications for certificates to teach;
(11) Requirements for a certificate to practice;
(12) The curricula, number of hours of instruction and training, and instructional materials to be used in adult and pediatric emergency medical services training programs and adult and pediatric emergency medical services continuing education programs;
(13) Procedures for conducting courses in recognizing symptoms of life-threatening allergic reactions and in calculating proper dosage levels and administering injections of epinephrine to adult and pediatric patients who suffer life-threatening allergic reactions;
(14) Procedures for conducting courses in recognizing symptoms of a possible life-threatening opioid overdose and administering naloxone to that patient;
(15) Examinations for certificates to practice;
(15)(16) Procedures for administering examinations for certificates to practice;
(16)(17) Procedures for approving examinations that demonstrate competence to have a certificate to practice renewed without completing an emergency medical services continuing education program;
(17)(18) Procedures for granting extensions and exemptions of emergency medical services continuing education requirements;
(18)(19) Procedures for approving the additional emergency medical services first responders are authorized by division (C) of section 4765.35 of the Revised Code to perform, EMTs-basic are authorized by division (C) of section 4765.37 of the Revised Code to perform, EMTs-I are authorized by division (B)(5) of section 4765.38 of the Revised Code to perform, and paramedics are authorized by division (B)(6) of section 4765.39 of the Revised Code to perform;
(19)(20) Standards and procedures for implementing the requirements of section 4765.06 of the Revised Code, including designations of the persons who are required to report information to the board and the types of information to be reported;
(20)(21) Procedures for administering the emergency medical services grant program established under section 4765.07 of the Revised Code;
(21)(22) Procedures consistent with Chapter 119. of the Revised Code for appealing decisions of the board;
(22)(23) Minimum qualifications and peer review and quality improvement requirements for persons who provide medical direction to emergency medical service personnel;
(23)(24) The manner in which a patient, or a patient's parent, guardian, or custodian, may consent to the board releasing identifying information about the patient under division (D) of section 4765.102 of the Revised Code;
(24)(25) Circumstances under which a training program or continuing education program, or portion of either type of program, may be taught by a person who does not hold a certificate to teach issued under section 4765.23 of the Revised Code;
(25)(26) Certification cycles for certificates issued under sections 4765.23 and 4765.30 of the Revised Code and certificates issued by the executive director of the state board of emergency medical services under section 4765.55 of the Revised Code that establish a common expiration date for all certificates.
(B) The board may adopt, and may amend and rescind, rules in accordance with Chapter 119. of the Revised Code and division (C) of this section that establish the following:
(1) Specifications of information that may be collected under the trauma system registry and incidence reporting system created under section 4765.06 of the Revised Code;
(2) Standards and procedures for implementing any of the recommendations made by any committees of the board or under section 4765.04 of the Revised Code;
(3) Requirements that a person must meet to receive a certificate to practice as a first responder pursuant to division (A)(2) of section 4765.30 of the Revised Code;
(4) Any other rules necessary to implement this chapter.
(C) In developing and administering rules adopted under this chapter, the state board of emergency medical services shall consult with regional directors and regional physician advisory boards created by section 4765.05 of the Revised Code and emphasize the special needs of pediatric and geriatric patients.
(D) Except as otherwise provided in this division, before adopting, amending, or rescinding any rule under this chapter, the board shall submit the proposed rule to the director of public safety for review. The director may review the proposed rule for not more than sixty days after the date it is submitted. If, within this sixty-day period, the director approves the proposed rule or does not notify the board that the rule is disapproved, the board may adopt, amend, or rescind the rule as proposed. If, within this sixty-day period, the director notifies the board that the proposed rule is disapproved, the board shall not adopt, amend, or rescind the rule as proposed unless at least twelve members of the board vote to adopt, amend, or rescind it.
This division does not apply to an emergency rule adopted in accordance with section 119.03 of the Revised Code.
Sec. 4765.16.  (A) All courses offered through an emergency medical services training program or an emergency medical services continuing education program, other than ambulance driving, shall be developed under the direction of a physician who specializes in emergency medicine. Each course that deals with trauma care shall be developed in consultation with a physician who specializes in trauma surgery. Except as specified by the state board of emergency medical services pursuant to rules adopted under section 4765.11 of the Revised Code, each course offered through a training program or continuing education program shall be taught by a person who holds the appropriate certificate to teach issued under section 4765.23 of the Revised Code.
(B) A training program for first responders shall meet the standards established in rules adopted by the board under section 4765.11 of the Revised Code. The program shall include courses in both each of the following areas for at least the number of hours established by the board's rules:
(1) Emergency victim care;
(2) Reading and interpreting a trauma victim's vital signs;
(3) Administration of naloxone.
(C) A training program for emergency medical technicians-basic shall meet the standards established in rules adopted by the board under section 4765.11 of the Revised Code. The program shall include courses in each of the following areas for at least the number of hours established by the board's rules:
(1) Emergency victim care;
(2) Reading and interpreting a trauma victim's vital signs;
(3) Triage protocols for adult and pediatric trauma victims;
(4) In-hospital training;
(5) Clinical training;
(6) Training as an ambulance driver;
(7) Administration of naloxone.
Each operator of a training program for emergency medical technicians-basic shall allow any pupil in the twelfth grade in a secondary school who is at least seventeen years old and who otherwise meets the requirements for admission into such a training program to be admitted to and complete the program and, as part of the training, to ride in an ambulance with emergency medical technicians-basic, emergency medical technicians-intermediate, and emergency medical technicians-paramedic. Each emergency medical service organization shall allow pupils participating in training programs to ride in an ambulance with emergency medical technicians-basic, advanced emergency medical technicians-intermediate, and emergency medical technicians-paramedic.
(D) A training program for emergency medical technicians-intermediate shall meet the standards established in rules adopted by the board under section 4765.11 of the Revised Code. The program shall include, or require as a prerequisite, the training specified in division (C) of this section and courses in each of the following areas for at least the number of hours established by the board's rules:
(1) Recognizing symptoms of life-threatening allergic reactions and in calculating proper dosage levels and administering injections of epinephrine to persons who suffer life-threatening allergic reactions, conducted in accordance with rules adopted by the board under section 4765.11 of the Revised Code;
(2) Venous access procedures;
(3) Cardiac monitoring and electrical interventions to support or correct the cardiac function.
(E) A training program for emergency medical technicians-paramedic shall meet the standards established in rules adopted by the board under section 4765.11 of the Revised Code. The program shall include, or require as a prerequisite, the training specified in divisions (C) and (D) of this section and courses in each of the following areas for at least the number of hours established by the board's rules:
(1) Medical terminology;
(2) Venous access procedures;
(3) Airway procedures;
(4) Patient assessment and triage;
(5) Acute cardiac care, including administration of parenteral injections, electrical interventions, and other emergency medical services;
(6) Emergency and trauma victim care beyond that required under division (C) of this section;
(7) Clinical training beyond that required under division (C) of this section.
(F) A continuing education program for first responders, EMTs-basic, EMTs-I, or paramedics shall meet the standards established in rules adopted by the board under section 4765.11 of the Revised Code. A continuing education program shall include instruction and training in subjects established by the board's rules for at least the number of hours established by the board's rules.
Sec. 4765.161.  Not later than three years after the effective date of this section, each first responder, emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic who on the effective date of this section holds a certificate issued under this chapter shall complete a course on naloxone administration developed under section 4765.11 of the Revised Code. The course may be used to meet the continuing education requirements of this chapter.
Sec. 4765.35.  (A) A first responder shall perform the emergency medical services described in this section in accordance with this chapter and any rules adopted under it.
(B) A first responder may provide limited emergency medical services to patients until the arrival of an emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic. In an emergency, a first responder may render emergency medical services such as opening and maintaining an airway, giving mouth to barrier ventilation, chest compressions, electrical interventions with automated defibrillators to support or correct the cardiac function and other methods determined by the board, controlling of hemorrhage, manual stabilization of fractures, bandaging, assisting in childbirth, administration of naloxone, and determining triage of trauma victims.
(C) A first responder may perform any other emergency medical services approved pursuant to rules adopted under section 4765.11 of the Revised Code. The board shall determine whether the nature of any such service requires that a first responder receive authorization prior to performing the service.
(D)(1) Except as provided in division (D)(2) of this section, if the board determines under division (C) of this section that a service requires prior authorization, the service shall be performed only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or pursuant to an authorization transmitted through a direct communication device by a physician or registered nurse designated by a physician.
(2) If communications fail during an emergency situation or the required response time prohibits communication, a first responder may perform services subject to this division, if, in the judgment of the first responder, the life of the patient is in immediate danger. Services performed under these circumstances shall be performed in accordance with the written protocols for triage of adult and pediatric trauma victims established in rules adopted under sections 4765.11 and 4765.40 of the Revised Code and any applicable protocols adopted by the emergency medical service organization with which the first responder is affiliated.
Sec. 4765.37.  (A) An emergency medical technician-basic shall perform the emergency medical services described in this section in accordance with this chapter and any rules adopted under it by the state board of emergency medical services.
(B) An emergency medical technician-basic may operate, or be responsible for operation of, an ambulance and may provide emergency medical services to patients. In an emergency, an EMT-basic may determine the nature and extent of illness or injury and establish priority for required emergency medical services. An EMT-basic may render emergency medical services such as opening and maintaining an airway, giving positive pressure ventilation, cardiac resuscitation, electrical interventions with automated defibrillators to support or correct the cardiac function and other methods determined by the board, controlling of hemorrhage, treatment of shock, immobilization of fractures, bandaging, assisting in childbirth, administration of naloxone, management of mentally disturbed patients, initial care of poison and burn patients, and determining triage of adult and pediatric trauma victims. Where patients must in an emergency be extricated from entrapment, an EMT-basic may assess the extent of injury and render all possible emergency medical services and protection to the entrapped patient; provide light rescue services if an ambulance has not been accompanied by a specialized unit; and after extrication, provide additional care in sorting of the injured in accordance with standard emergency procedures.
(C) An EMT-basic may perform any other emergency medical services approved pursuant to rules adopted under section 4765.11 of the Revised Code. The board shall determine whether the nature of any such service requires that an EMT-basic receive authorization prior to performing the service.
(D)(1) Except as provided in division (D)(2) of this section, if the board determines under division (C) of this section that a service requires prior authorization, the service shall be performed only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or pursuant to an authorization transmitted through a direct communication device by a physician or registered nurse designated by a physician.
(2) If communications fail during an emergency situation or the required response time prohibits communication, an EMT-basic may perform services subject to this division, if, in the judgment of the EMT-basic, the life of the patient is in immediate danger. Services performed under these circumstances shall be performed in accordance with the protocols for triage of adult and pediatric trauma victims established in rules adopted under sections 4765.11 and 4765.40 of the Revised Code and any applicable protocols adopted by the emergency medical service organization with which the EMT-basic is affiliated.
Section 2.  That existing sections 3701.74, 4723.481, 4723.50, 4730.39, 4730.40, 4730.43, 4765.11, 4765.16, 4765.35, and 4765.37 of the Revised Code are hereby repealed.
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