Section 13-516 - Emergency medical services; Board; license or certificate.
§ 13-516. Emergency medical services; Board; license or certificate.
(a) Definitions.-
(1) In this section the following words have the meanings indicated.
(2) "Cardiac rescue technician" (CRT) means an individual who has:
(i) Completed a cardiac rescue technician course approved by the EMS Board;
(ii) Demonstrated competence in medical protocols within this State as determined by the EMS Board; and
(iii) Been examined by the EMS Board and licensed as a CRT by the EMS Board.
(3) "Certificate" means a certificate issued by the EMS Board to provide emergency medical services in the State, except where the context requires otherwise.
(4) "Emergency medical dispatcher" (EMD) means an individual who has:
(i) Completed an emergency medical dispatcher course approved by the EMS Board or its equivalent as determined by the EMS Board;
(ii) Demonstrated competence in medical protocols as determined by the EMS Board; and
(iii) Been examined by the EMS Board or has been recognized as an emergency medical dispatcher by an emergency medical dispatcher program approved by the EMS Board and licensed as an emergency medical dispatcher by the EMS Board.
(5) "Emergency medical services" means:
(i) Medical services provided prehospital to prevent imminent death or aggravation of illness or injury whether or not transport to a hospital or appropriate facility occurs;
(ii) Transport from the scene of a medical emergency to a hospital or appropriate facility whether or not medical services are provided;
(iii) Medical interfacility transport services to an appropriate facility; or
(iv) Medical interfacility critical care transport to an appropriate facility.
(6) "Emergency medical services provider" means an individual licensed or certified by the EMS Board as:
(i) A cardiac rescue technician;
(ii) An emergency medical dispatcher;
(iii) An emergency medical technician-basic;
(iv) An emergency medical technician-paramedic; or
(v) A first responder.
(7) "Emergency medical technician-basic" (EMT-B) means an individual who has:
(i) Completed an emergency medical technician-basic course approved by the EMS Board;
(ii) Demonstrated competence in medical protocols as determined by the EMS Board; and
(iii) Been examined by the EMS Board and certified as an EMT-B by the EMS Board.
(8) "Emergency medical technician-paramedic" (EMT-P) means an individual who has:
(i) Completed an emergency medical technician-paramedic course approved by the EMS Board;
(ii) Been tested and registered by the National Registry of Emergency Medical Technicians, Inc. as an emergency medical technician-paramedic;
(iii) Demonstrated competence in medical protocols within this State as determined by the EMS Board; and
(iv) Been licensed as an EMT-P by the EMS Board.
(9) "First responder" means an individual who has:
(i) Completed a first responder course approved by the EMS Board; and
(ii) Been examined by the EMS Board and certified as a first responder by the EMS Board.
(10) "License" means a license issued by the EMS Board to provide emergency medical services in the State, unless the context requires otherwise.
(11) (i) "Medical direction" means the written or oral instruction by a licensed physician to perform specified medical procedures or administer specified medications or intravenous solutions.
(ii) "Medical direction" includes the activities of a licensed physician in the State serving as a medical director for an agency providing emergency medical services including quality assurance, planning, and education.
(12) "National registry" means the nonproprietary, nongovernmental agency that provides standardized national testing and registration for emergency medical technicians based on national training standards.
(13) "Provider review panel" means the 13-member panel appointed by the EMS Board in accordance with the provisions of subsection (e) of this section.
(14) "Public safety personnel" means:
(i) Any career or volunteer member of a fire, rescue or EMS department, company, squad or auxiliary;
(ii) Any law enforcement officer; or
(iii) The State Fire Marshal or a sworn member of the State Fire Marshal's office.
(b) License or certificate required.-
(1) Except as otherwise provided in this section, an individual may not provide emergency medical services in the State unless issued a license or certificate by the EMS Board under this section.
(2) This section does not apply to:
(i) An individual who:
1. Has completed an emergency medical services course or its equivalent as determined by the EMS Board;
2. Is authorized to provide emergency medical services by any state adjoining this State;
3. Is called on by a public safety agency providing emergency medical services to render emergency medical services in this State or to transport emergency patients from the adjoining state to a health care facility in this State;
4. Is providing emergency medical services within the scope of the license or certificate issued to the individual by the other state; and
5. Is not affiliated with an emergency medical service in this State or is not engaged in providing emergency medical services in this State on a regular basis;
(ii) An individual who is enrolled in an emergency medical services provider training program that meets the standards set by the EMS Board in the course of that training;
(iii) An individual who is not engaged in providing emergency medical services on a regular basis who provides emergency medical services at the scene of a medical emergency in rare instances;
(iv) An individual who is a member of a volunteer fire or rescue company and solely engaged in driving the emergency vehicle;
(v) An individual who assists an emergency medical services provider but does not directly provide emergency medical services; or
(vi) An individual who has American Red Cross first aid training or its equivalent and who provides services within the scope of that training, does not respond to emergency calls, and does not transport patients.
(3) This subsection does not limit the right of an individual to practice a health occupation that the individual is authorized to practice under the Health Occupations Article.
(4) A person who violates any provision of this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year or both.
(c) Application; fees; renewal.-
(1) To apply for a license or certificate, an individual shall:
(i) Submit an application on the form that the EMS Board requires; and
(ii) Pay to the EMS Board any application fee set by the EMS Board under subsection (m) of this section.
(2) The EMS Board may not charge a licensing, certifying, testing, or retesting fee to any individual who is a member or employee of any governmental or volunteer fire, rescue, or emergency medical services company at the date of application.
(3) The EMS Board shall provide for the term and renewal of licenses or certificates issued under this section.
(d) Adoption of rules and regulations.-
(1) The EMS Board may adopt rules, regulations, protocols, orders, and standards to carry out the provisions of this section.
(2) Any regulations of the EMS Board relating to the practice of medicine shall be adopted jointly with the Board of Physicians.
(3) Any regulations of the EMS Board relating to the practice of nursing shall be adopted in collaboration with the Board of Nursing.
(e) Provider review panel.-
(1) (i) There is a provider review panel to the EMS Board.
(ii) The provider review panel shall be appointed by the EMS Board.
(2) The provider review panel consists of 13 members, 11 voting members appointed by the EMS Board and two nonvoting members.
(3) Eight of the appointed members shall be licensed or certified emergency medical service providers who are actively providing emergency medical services at the time of their appointment. Three shall be members of a governmental fire, rescue, or emergency medical services company, three shall be members of a volunteer fire, rescue, or emergency medical services company, one shall be an employee of a commercial ambulance service, and one shall be an emergency medical dispatcher. In appointing the provider representatives of the provider review panel, the Board shall give consideration to providing for reasonable representation from throughout the State.
(4) One of the appointed members shall be a physician appointed by the Board of Physicians.
(5) One of the appointed members shall be a medical director with emergency medical services experience.
(6) One of the appointed members shall be a representative of the Medical and Chirurgical Faculty of the State of Maryland who has emergency medical services experience.
(7) The Executive Director of the Institute and the State EMS Medical Director shall serve as nonvoting ex officio members.
(8) The panel shall elect a chairman from among its members.
(9) The EMS Board shall adopt regulations for the selection, appointment, and terms of the members of the panel, including providing for the staggering of terms.
(10) (i) The provider review panel shall review patient care and other allegations of misconduct against emergency medical services providers and provide recommendations to the EMS Board for further action as necessary.
(ii) The provider review panel shall perform any other duty or function that the EMS Board requires.
(f) Performance of specified medical procedures; dispatchers; first responders.-
(1) Subject to the rules, regulations, protocols, orders, and standards of the EMS Board and subject to medical direction, while providing emergency medical services:
(i) A cardiac rescue technician, an emergency medical technician-B, or an emergency medical technician-P may:
1. Perform specified medical procedures as authorized by the EMS Board;
2. Administer specified medications or intravenous solutions; and
3. Provide emergency medical transport;
(ii) An emergency medical dispatcher may:
1. Perform medical interrogation in order to determine the type and level of response required at the scene of a medical emergency; and
2. Provide prearrival instructions including instructions in cardiopulmonary resuscitation; and
(iii) A first responder:
1. May perform specified medical procedures as defined by the EMS Board; and
2. May not be the primary emergency medical services provider during emergency medical transport.
(2) Participation in emergency medical dispatch programs by jurisdictions is totally voluntary.
(g) Influenza and hepatitis B immunizations and tuberculosis skin testing.- Subject to the rules, regulations, protocols, orders, and standards of the EMS Board, an EMT-P may administer influenza and hepatitis B immunizations and tuberculosis skin testing, in a nonemergency environment, to public safety personnel within the jurisdiction of the EMT-P, if the services are:
(1) Authorized by a written agreement between the provider's jurisdictional EMS operational program medical director and the county or city health department in whose jurisdiction the services are performed, which shall include provisions for documentation, referral and follow-up, and storage and inventory of medicine;
(2) Under the direction of the jurisdictional EMS operational program medical director; and
(3) Approved by the Institute.
(h) Reprimand, suspension, and revocation.-
(1) Subject to the hearing provisions of subsection (i) of this section and as a result of any conduct of an emergency medical services provider or an applicant for a license or certificate under this section that is prohibited under the provisions of this section or any regulations adopted under this section, the EMS Board may:
(i) Reprimand or place an emergency medical services provider on probation;
(ii) Suspend or revoke the license or certificate of an emergency medical services provider;
(iii) Deny a license or certificate to an applicant; or
(iv) Refuse to renew an applicant's license or certificate.
(2) On the application of an individual whose license or certificate has been suspended or revoked, the EMS Board may reinstate a suspended or revoked license or certificate.
(3) (i) Unless the EMS Board agrees to accept the surrender of a license or certificate, a holder of a license or certificate may not surrender the license or certificate.
(ii) A license or certificate may not lapse by operation of law while the holder of the license or certificate is under investigation or while charges are pending against the holder of the license or certificate.
(4) The EMS Board may set conditions on its agreement with the holder of the license or certificate under investigation or against whom charges are pending to accept surrender of the license or certificate.
(i) Review and hearing; representation.-
(1) The EMS Board may take action under subsection (h) of this section only after:
(i) A review and recommendation by the provider review panel; and
(ii) After the individual against whom the action is contemplated has had an opportunity for a hearing in accordance with the provisions of Title 10, Subtitle 2 of the State Government Article.
(2) The EMS Board may not proceed with disciplinary cases concerning patient care except upon the affirmative recommendation of the provider review panel.
(3) The individual may be represented at the hearing by counsel.
(4) Any person aggrieved by a decision of the EMS Board may take any further appeal allowed under Title 10, Subtitle 2 of the State Government Article.
(j) Board of Nursing.-
(1) The EMS Board shall refer to the Board of Nursing any complaint about an emergency medical services provider who, in addition to being licensed or certified by the EMS Board, is licensed as a registered nurse or licensed practical nurse by the Board of Nursing.
(2) The Board of Nursing may investigate and discipline a registered nurse or licensed practical nurse for a violation of this section and a violation of Title 8 of the Health Occupations Article.
(3) The Board of Nursing shall conduct any hearing required by this section in accordance with § 8-317 of the Health Occupations Article.
(4) The EMS Board shall comply with any recommendation or order issued by the Board of Nursing regarding the issuance of a license or certificate by the EMS Board to an individual who is licensed as a registered nurse or licensed practical nurse.
(k) Enforcement; subpoenas.-
(1) The EMS Board may, over the signature of the chairman of the EMS Board, Executive Director of the Institute, chairman of the provider review panel, or State EMS Medical Director, issue subpoenas and administer oaths in connection with any investigation under this section and any hearings or proceedings before it.
(2) If, without lawful excuse, a person disobeys a subpoena of the EMS Board or an order by the EMS Board to take an oath or to testify or answer a question, a court of competent jurisdiction may punish the person for contempt.
(3) If, after due notice, the individual against whom an action is contemplated fails or refuses to appear, the EMS Board may hear and determine the matter.
(4) If the entry is necessary to carry out a duty under this section, any duly authorized agent or investigator of the EMS Board may enter at any reasonable hour a place of business of a licensed or certified emergency medical services provider or public premises.
(5) The EMS Board may issue a cease and desist order or obtain injunctive relief if a person provides emergency medical services without a license or certificate.
(l) Penalties.-
(1) A person who violates any provision of this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year or both.
(2) Unless licensed or certified to provide emergency medical services under this section, a person may not represent to the public that the person is authorized to provide emergency medical services in this State.
(3) Unless licensed or certified to provide emergency medical services under this section, a person may not use the terms "cardiac rescue technician", "CRT", "emergency medical dispatcher", "EMD", "emergency medical technician", "EMT-B", "EMT-P", "paramedic", or "first responder" or any other words, letters, or symbols with the intent to represent that the person is authorized to provide emergency medical services.
(m) EMS Board Provider Fund.-
(1) There is an EMS Board Provider Fund.
(2) Except as provided in paragraph (3) of this subsection, the EMS Board may set reasonable fees for the initial issuance of licenses or certificates and its other services.
(3) (i) The EMS Board may not charge an initial licensing fee, an initial certifying fee, a fee for the renewal of a license, a fee for the renewal of a certificate, a testing fee, or a retesting fee to an individual who is a member or employee of any governmental or volunteer fire or rescue company at the time of that individual's application.
(ii) The EMS Board shall pay all fees collected under the provisions of this section to the Comptroller of the State.
(iii) The Comptroller of the State shall distribute the fees to the EMS Board Provider Fund.
(4) The EMS Board Provider Fund shall be used exclusively to fund the actual documented direct and indirect costs of fulfilling the statutory and regulatory duties of the EMS Board as provided by the provisions of this section.
(5) (i) The EMS Board Provider Fund is a continuing, nonlapsing fund and is not subject to § 7-302 of the State Finance and Procurement Article.
(ii) Any unspent portion of the EMS Board Provider Fund may not be transferred or revert to the General Fund of the State but shall remain in the EMS Board Provider Fund to be used for the purposes specified in this section.
(n) Delegation of Board's authority.-
(1) The EMS Board may delegate any portion of its authority under this section to the Executive Director of the Institute unless specifically precluded by statute.
(2) Notice of any delegation of authority made under this section shall be published in the Maryland Register.
(3) The EMS Board may not delegate its authority to promulgate and revise regulations, hear contested cases, or designate the provider review panel to the Executive Director of the Institute.
(4) The EMS Board may delegate to the Office of Administrative Hearings the authority to hear contested cases and issue recommendations.
[1997, ch. 201, § 1; 1998, ch. 46; 2000, ch. 61, §§ 1, 6; ch. 174; 2003, ch. 252, § 10; 2006, ch. 68; 2007, ch. 5; 2010, chs. 272, 272.]