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108th Congress                                                   Report
                                 SENATE                          
 2d Session                                                     108-291
_______________________________________________________________________

                                     

                                                       Calendar No. 607


                 EMERGENCY MEDICAL SERVICES SUPPORT ACT

                               __________

                              R E P O R T

                                 of the

         COMMITTEE ON GOVERNMENTAL AFFAIRS UNITED STATES SENATE

                              to accompany

                                S. 2351

   TO ESTABLISH A FEDERAL INTERAGENCY COMMITTEE ON EMERGENCY MEDICAL 
   SERVICES AND A FEDERAL INTERAGENCY COMMITTEE ON EMERGENCY MEDICAL 
           SERVICES ADVISORY COUNCIL, AND FOR OTHER PURPOSES




                 June 30, 2004.--Ordered to be printed

   Filed, under authority of the order of the Senate of June 25, 2004
                   COMMITTEE ON GOVERNMENTAL AFFAIRS

                   SUSAN M. COLLINS, Maine, Chairman
TED STEVENS, Alaska                  JOSEPH I. LIEBERMAN, Connecticut
GEORGE V. VOINOVICH, Ohio            CARL LEVIN, Michigan
NORM COLEMAN, Minnesota              DANIEL K. AKAKA, Hawaii
ARLEN SPECTER, Pennsylvania          RICHARD J. DURBIN, Illinois
ROBERT F. BENNETT, Utah              THOMAS R. CARPER, Delaware
PETER G. FITZGERALD, Illinois        MARK DAYTON, Minnesota
JOHN E. SUNUNU, New Hampshire        FRANK LAUTENBERG, New Jersey
RICHARD C. SHELBY, Alabama           MARK PRYOR, Arkansas

           Michael D. Bopp, Staff Director and Chief Counsel
              Tim Raducha-Grace, Professional Staff Member
      Joyce A. Rechtschaffen, Minority Staff Director and Counsel
         Michael Alexander, Minority Professional Staff Member
                      Amy B. Newhouse, Chief Clerk


                                                       Calendar No. 607
108th Congress                                                   Report
                                 SENATE
 2d Session                                                     108-291

======================================================================



 
                 EMERGENCY MEDICAL SERVICES SUPPORT ACT

                                _______
                                

                 June 30, 2004.--Ordered to be printed

   Filed, under authority of the order of the Senate of June 25, 2004

                                _______
                                

Ms. Collins, from the Committee on Governmental Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 2351]

    The Committee on Governmental Affairs, to whom was referred 
the bill (S. 2351) to establish a Federal Interagency Committee 
on Emergency Medical Services and a Federal Interagency 
Committee on Emergency Medical Services Advisory Council, and 
for other purposes, having considered the same reports 
favorably thereon and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................1
 II. Background.......................................................2
III. Legislative History..............................................4
 IV. Section-by-Section...............................................4
  V. Evaluation of Regulatory Impact..................................6
 VI. CBO Cost Estimate................................................6
VII. Changes to Existing Law..........................................7

                         I. Purpose and Summary

    The Senate Governmental Affairs Committee (the Committee) 
approved S. 2351, the Emergency Medical Services Support Act, 
on June 2, 2004. This legislation would formally establish the 
Federal Interagency Committee on Emergency Medical Services 
(FICEMS) to enhance coordination among a number of federal 
agencies and maximize the best use of funding for emergency 
medical services. This legislation would also establish a 
FICEMS Advisory Council, which would create a mechanism for 
individuals at the state and local levels to provide input into 
how Federal emergency medical service (EMS) programs should be 
coordinated.

                             II. Background

    For the past 20 years, Federal support for EMS has been 
both scarce and uncoordinated. Since the last major Federal EMS 
infrastructure investment, the Emergency Services Systems Act 
of 1973 (Pub. L. 93-154, repealed on August 13, 1981, by Pub. 
L. 97-35), support for EMS has been spread among a number of 
agencies, including the Department of Transportation's National 
Highway Traffic Safety Administration (NHTSA), the Department 
of Health and Human Services' Health Resources and Services 
Administration, the Centers for Disease Control and Prevention, 
the Department of Homeland Security's Emergency Preparedness 
and Response Directorate, the United States Fire 
Administration, the Office for Domestic Preparedness, and the 
Centers for Medicare and Medicaid Services. Most of the support 
offered by these agencies has focused only on specific system 
functions, rather than on overall system capacity, and has been 
inconsistent and ineffectively coordinated.
    In 2001, at the request of Senators Collins and Feingold, 
the General Accounting Office (GAO) completed its report, 
``Emergency Medical Response: Reported Needs Are Wide-Ranging, 
With Lack of Data A Growing Concern,'' (GAO-02-28) which 
illustrated the need to increase coordination among Federal 
agencies as they address the needs of regional, state, or local 
emergency medical services systems. According to GAO, these 
needs, including personnel, training, and equipment, vary 
between urban and rural communities.
    The Committee believes that the need for Federal support 
and coordination is especially critical with the increasing 
burden placed on state and local EMS systems by homeland 
defenseand security issues. In a mass casualty event, 
communities rely on their EMS system to provide front line medical care 
for the first 12 to 24 hours, before Federal resources become 
available. Yet many local systems lack the skills and resources needed 
to detect, respond to, and manage mass casualty incidents. Without 
adequate preparation, local systems are likely to become quickly 
incapacitated, leaving the community with no EMS coverage for even 
routine emergencies such as motor vehicle crashes and cardiac arrests.
    EMS systems also require substantial development to realize 
their potential as key elements of our communities' emergency 
medical safety nets. A number of sources of information are 
available to identify specific strengths and weaknesses in EMS 
systems. These include the Statewide EMS Assessments conducted 
by NHTSA in 48 States between 1988-2001, the 1996 EMS Agenda 
for the Future, a survey of State EMS Directors conducted in 
2000 by the Office of Rural Health Policy in the Department of 
Health and Human Services, and a 2001 General Accounting Office 
Report on Emergency Medical Response.
    These sources consistently indicate shortcomings in EMS 
systems in several critical areas, including emergency 
communications, trauma system development, EMS information 
systems, and rural EMS. EMS communications systems are a 
particular weak point. For example, no state has yet fully 
implemented wireless E9-1-1, a shortcoming that prevents 
emergency responders from automatically locating people who 
call 9-1-1 from wireless phones. Communication among emergency 
providers is also lacking, especially in rural areas where 
nearly three quarters of EMS systems lack the ability to 
reliably communicate among dispatchers, ambulances, and 
hospitals.
    Trauma system development is critically needed, with 61 
percent of States lacking triage protocols for transporting 
patients to specialty care facilities, such as trauma centers, 
burn centers, and pediatric centers. EMS information systems 
are another weakness, with over 90 percent of States lacking 
critical components of the comprehensive data systems needed to 
efficiently manage EMS resources, respond to daily emergencies, 
and provide adequate surveillance to detect acts of terrorism 
such as chemical, nuclear, or biological events. Other 
shortcomings identified by these studies include EMS medical 
direction, recruitment and retention of EMS personnel, and EMS 
research.
    This legislation would enhance support for EMS, 9-1-1 
systems, and improve emergency response capacity nationwide by 
formally establishing a Federal Interagency Committee on 
Emergency Medical Services (FICEMS), which is currently an ad-
hoc committee with insufficient formal direction. FICEMS would 
enhance coordination among the federal agencies involved with 
the state, local, tribal and regional emergency medical 
services and 9-1-1 systems. Improved coordination would also 
maximize the use of established funding. FICEMS activities 
would include preparing an annual report to Congress on the 
Committee's activities, actions, and recommendations.
    The President has also recognized the need for this 
coordination. He included a similar proposal in his 
reauthorization proposal for the ``Safe, Accountable, Flexible, 
and Efficient Transportation Equity Act of 2003'' (SAFETEA) 
that was transmitted by Secretary Mineta to Congress on May 12, 
2003. The Senate-passed Transportation legislation, the Safe, 
Accountable, Flexible, and Efficient Transportation Equity Act 
of 2003 (S. 1072), also includes a similar proposal.
    S. 2351 builds upon the Administration's proposal by 
creating a more effective structure and incorporating the input 
of local EMS providers into federal EMS programs. Most 
significantly, this legislation creates a FICEMS Advisory 
Council, which establishes a mechanism for individuals at the 
state and local levels to provide input regarding how Federal 
EMS programs should be coordinated. The FICEMS Advisory Council 
established under this legislation would consist of 13 
individuals with interest or expertise in emergency medical 
services and would be selected by FICEMS. The Advisory Council 
would also review FICEMS' annual report summarizing its 
activities, actions, and recommendations.
    The Advisory Council would also assist FICEMS in its 
ongoing mission, which includes activities to:
          (1) Ensure coordination among the Federal agencies 
        involved with State, local, Tribal, or regional 
        emergency medical services and 9-1-1 systems;
          (2) Ensure that emergency medical services are 
        appropriately integrated with homeland security and 
        other emergency response programs;
          (3) Identify State, local, Tribal, or regional 
        emergency services and 9-1-1 system needs;
          (4) Recommend new or expanded programs, including 
        grant programs, for improving State, local, Tribal, or 
        regional emergency medical services and implementing 
        improved EMS technologies, including wireless E9-1-1;
          (5) Identify ways to streamline the process through 
        which Federal agencies support State, local, Tribal, or 
        regional emergency medical services; and
          (6) Assist State, local, Tribal, or regional 
        emergency medical services in setting priorities based 
        on identified needs.
    A wide range of organizations representing State and local 
EMS stakeholders have identified the need for this legislation. 
The Advocates for EMS, the American Ambulance Association, the 
American Heart Association, the Association of Air Medical 
Services, the Emergency Nurses Association, the National 
Association of Emergency Medical Services Educators, the 
National Association of Emergency Medical Services Physicians, 
the National Association of Emergency Medical Technicians, the 
National Association of State Emergency Medical Services 
Directors, and the National Registry of Emergency Medical 
Technicians have all urged Congress to enact S. 2351 as soon as 
possible.

                        III. Legislative History

    S. 2351 was introduced on April 27, 2004 by Senator Susan 
Collins and Senator Russell Feingold and was referred to the 
Committee on Governmental Affairs. The SenateGovernmental 
Affairs Committee met on June 2, 2004 and by voice vote approved S. 
2351 without amendment. Senators present: Voinovich, Bennett, 
Fitzgerald, Lieberman, Levin, Akaka, Carper, Lautenberg, and Collins.

                         IV. Section by Section

    Section 1 states S. 2351's title, the Emergency Medical 
Services Support Act.
    Section 2 of this legislation would establish the Federal 
Interagency Committee on Emergency Medical Services. 
Subparagraph (a) would direct the Secretary of Transportation 
and the Secretary of Homeland Security through the Under 
Secretary for Emergency Preparedness and Response, in 
consultation with the Secretary of Health and Human Services, 
to establish a Federal Interagency Committee on Emergency 
Medical Services to provide intergovernmental coordination of 
emergency medical services.
    Subparagraph (b) establishes the Interagency Committee's 
membership which would consist of the following officials, or 
their designees: NHTSA Administrator; Director, Office for 
Domestic Preparedness, Department of Homeland Security; 
Administrator of the Health Resources and Services 
Administration, HHS; Director of the Centers for Disease 
Control and Prevention; Administrator of United States Fire 
Administration, Emergency Preparedness and Response 
Directorate, Department of Homeland Security; Director of the 
Center for Medicare and Medicaid Services; Under Secretary of 
Defense for Personnel and Readiness, Department of Defense; 
Assistant Secretary for Public Health Emergency Preparedness, 
Department of Health and Human Services; Director, Indian 
Health Service, Department of Health and Human Services; Chief, 
Wireless Telecom Bureau of the Federal Communications 
Commission; and representatives of any other Federal agency 
identified by the Secretary of Transportation or the Secretary 
of Homeland Security through the Under Secretary for Emergency 
Preparedness and Response, in consultation with the Secretary 
of Health and Human Services, as having a significant role in 
relation to the purposes of the Interagency Committee on EMS.
    Subparagraph (c) would require FICEMS members to annually 
select a Chairperson of the Committee.
    Subparagraph (d) would require the Committee to (1) ensure 
coordination among the Federal agencies involved with State, 
local, Tribal, or regional emergency medical services and 9-1-1 
systems; (2) identify State, local, Tribal, or regional 
emergency services and 9-1-1 system needs; (3) ensure that 
emergency medical services are appropriately integrated with 
homeland security and other emergency response programs; (4) 
recommend new or expanded programs, including grant programs, 
for improving State, local, Tribal, or regional emergency 
medical services and implementing improved EMS technologies, 
including wireless E9-1-1; (5) identify ways to streamline the 
process through which Federal agencies support State, local, 
Tribal, or regional emergency medical services; (6) assist 
State, local, Tribal, or regional emergency medical services in 
setting priorities based on identified needs; and (7) advise, 
consult with, and make recommendations on matters relating to 
the implementation of the coordinated with emergency medical 
services programs.
    Subparagraph (e) would require FICEMS to meet as frequently 
as is determined necessary by the chairperson, but no less 
frequently than quarterly.
    Subparagraph (f) would require NHTSA, in cooperation with 
the Director, Office for Domestic Preparedness, Department of 
Homeland Security, to provide administrative support to the 
Committee, including scheduling meetings, setting agendas, 
keeping minutes and records, and producing reports.
    Subparagraph (g) would require FICEMS to prepare an annual 
report to Congress on the Committee's activities, actions, and 
recommendations.
    Section 3 would establish a FICEMS Advisory Council (the 
Advisory Council). Subparagraph (a) would require the Advisory 
Council to consist of not more than 13 individuals with an 
interest or expertise in emergency services. Subparagraph (b) 
would require the Advisory Council's members to represent both 
rural and urban areas. Subparagraph (c) would require the 
members of the Advisory Council to annually select an 
individual from among the members of the Council to serve as 
chairperson.
    Subparagraph (d) would require the Advisory Council to make 
recommendations regarding: (1) Improved coordination and 
support of EMS systems among the federal programs; (2) 
Development of a national EMS plan: (3) Standards, guidelines, 
benchmarks, and data collection; (4) Guidelines for conducting 
needs assessments for improving community-based emergency 
medical services systems at State and local levels; (5) 
Creation of new or expansion of existing grants or other 
programs for improving community-based emergency medical 
services; (6) Consolidation or realignment of Federal agency or 
program responsibility for emergency medical services; (7) 
Strengthening EMS systems through enhanced workforce 
development, education, training, exercises, equipment, medical 
oversight, and other areas; and (8) Issues or topics to be 
addressed in the annual report of the Interagency Committee, 
review the annual report of the Interagency Committee, and 
include independent information or recommendations for 
inclusion in the report as deemed appropriate by the Advisory 
Council.
    Subparagraph (e) would require the Advisory Council to 
review the Interagency Committee's annual report before its 
submission to Congress. Subparagraph (f) would require the 
Advisory Council to meet at the same time and place as the 
Interagency Committee on EMS and conduct independent meetings 
to receive public comment and collect data and information. 
Subparagraph (g) establishes that the members of the Advisory 
Council shall receive no pay by reason of their service on the 
Advisory Council, but shall be allowed travel expenses, 
including per diem in lieu of subsistence at rates authorized 
under subchapter 1 of chapter 57 of title 5, United States 
Code. Subparagraph (h) would direct the Administrator of NHTSA, 
in cooperation with the Director of the Office for Domestic 
Preparedness of the Department of Homeland Security to provide 
administrative support to the Advisory Council.

                   V. Evaluation of Regulatory Impact

    Pursuant to the requirements of paragraph 11(b) of rule 
XXVI of the Standing Rules of the Senate, the Committee has 
considered the regulatory impact of this bill. CBO states that 
there are no intergovernmental or private-sector mandates as 
defined in the Unfunded Mandates Reform Act and no costs on 
State, local, or tribal governments. The legislation contains 
no other regulatory impact.

                         VI. CBO Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 14, 2004.
Hon. Susan M. Collins,
Chairman, Committee on Governmental Affairs,
U.S. Senate, Washington, DC.
    Dear Madam Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 2351, the Emergency 
Medical Services Support Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Rachel 
Milberg.
            Sincerely,
                                      Elizabeth M. Robinson
                               (For Douglas Holtz-Eakin, Director).
    Enclosure.

S. 2351--Emergency Medical Services Support Act

    S. 2351 would direct the Secretary of Transportation and 
the Secretary of Homeland Security to establish a Federal 
Interagency Committee on Emergency Medical Services. This 
committee would improve coordination among federal programs 
related to emergency medical services, recommend new programs 
or expansions to existing programs in order to meet the needs 
of state and local governments, and submit a report to the 
Congress each year on the committee's activities.
    Assuming appropriation of the necessary amounts, CBO 
estimates that implementing the bill would cost about $1 
million each year beginning in fiscal year 2005. This estimate 
is based on the cost of similar commissions. Enacting the bill 
would not affect direct spending or revenues.
    S. 2351 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Rachel Milberg. 
This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

                      VII. Changes to Existing Law

    S. 2351 is a freestanding provision of law that does not 
amend existing law.