,,ii  #aac? ,,congress  #b;d ,session   
,s4 #bdjj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #bb1 #bjad ,mr4   
,b5net 7= himself1 ,mr4 ,crapo1 & ,mr4  
,johnson ( ,s\? ,dakota7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,heal?1 ,education1  
,labor1 & ,p5sions  ,a ,,bill  ,to      
provide = improvem5t ( field em]g5cy    
m$ical s]vices1 & = o!r purposes4  #a4  
,%ort title2 table ( cont5ts  7a7  ,%ort
 title  ,?is ,act may be cit$ z ! ,field
 ,,ems ,innovation ,act4  7b7  ,table ( 
cont5ts  ,! table ( cont5ts ( ?is ,act  
is z foll[s3  ,sec4 #a4 ,%ort title2    
table ( cont5ts4 ,sec4 #b4 ,f9d+s4 ,sec4
 #c4 ,recognition ( ,,hhs z prim>y      
,f$]al ag5cy = em]g5cy m$ical s]vices & 
trauma c>e4 ,sec4 #d4 ,em]g5cy m$ical   
s]vices4 ,sec4 #e4 ,enhanc+ rese>* 9    
field ,,ems4 ,sec4 #f4 ,em]g5cy ,m$ical 
,s]vices ,tru/ ,fund4 ,sec4 #g4         
,au?orization ( appropriations4 ,sec4   
#h4 ,/atutory con/ruction4  #b4  ,f9d+s 
,congress f9ds ! foll[+3  7#a7 ,all     

p]sons ?r\gh\t ! ,unit$ ,/ates %\ld h   
access to & receive high-quality em]g5cy
 m$ical c>e z "p ( a coord9at$ em]g5cy  
m$ical s]vices sy/em4  7#b7 ,prop]ly    
function+ em]g5cy m$ical s]vices 7ref]r$
 to 9 ?is section z ,,ems7 sy/ems1 #bd  
h\rs p] day1 #g days p] week1 are       
ess5tial to ensure access to em]g5cy    
m$ical c>e & transport = all pati5ts )  
em]g5cy m$ical conditions4 ,su*         
coord9at$ ,,ems sy/ems are also necess>y
 = response to cata/rophic incid5ts4    
7#c7 ,ensur+ high-quality &             
co/-effective ,,ems sy/ems requires     
read9ess1 prep>$ness1 m$ical direction1 
ov]sight1 & innovation ?r\gh\t !        
cont9uum ( em]g5cy m$ical c>e ?r\gh     
,f$]al1 ,/ate1 & local                  
multijurisdictional collaboration &     
suffici5t res\rces = ,,ems ag5cies &    
provid]s4  7#d7 ,at ! ,f$]al level1     
,,ems responsibilities & res\rces (     
sev]al ,f$]al ag5cies consi/5t ) _!     
exp]tise & au?ority mu/ emphasize !     
critical importance ( ,f$]al ag5cy      

collaboration & coord9ation = all       
em]g5cy m$ical s]vices4  7#e7 ,at !     
,/ate & local level1 ,,ems sy/ems &     
ag5cies require ! coord9ation & improv$ 
capabilities ( multiple & div]se        
/akehold]s4  7#f7 ,em]g5cy m$ical       
s]vices encompass ! provision ( c>e     
provid$ to pati5ts ) em]g5cy m$ical     
conditions ?r\gh\t ! cont9uum1 includ+  
em]g5cy m$ical c>e & trauma c>e provid$ 
9 ! field1 hospital1 & rehabilitation   
sett+s4  7#g7 ,field ,,ems comprises    
ess5tial em]g5cy m$ical s]vices1 includ+
 m$ical c>e or m$ical transport provid$ 
to pati5ts prior to or outside m$ical   
facilities & o!r cl9ical sett+s4 ,!     
prim>y purpose ( field em]g5cy m$ical   
s]vices is to ensure t em]g5cy m$ical   
pati5ts receive ! "r c>e at ! "r place 9
 ! "r am\nt ( "t4  7#h7 ,coord9at$ &    
high-quality field ,,ems is ess5tial to 
! ,nation's security4 ,field ,,ems is an
 ess5tial public s]vice provid$ by      
gov]nm5tal & nongov]nm5tal ag5cies &    
practition]s #bd h\rs a day1 #g days a  

week1 & dur+ cata/rophic incid5ts4 ,to  
ensure disa/] & all-haz>ds prep>$ness = 
,,ems op]ations z "p ( ! ,nation's      
compreh5sive disa/] prep>$ness1 ,f$]al  
fund+ = prep>$ness activities1 includ+  
cata/rophic tra9+ & drills1 mu/ be      
provid$ to gov]nm5tal & nongov]nm5tal   
,,ems ag5cies to ensure a great]        
capability )9 ea* ( ^! areas4  7#i7     
,num]\s recomm5dations f sev]al         
significant national reports & docum5ts 
h demon/rat$ ! ne$ 9 multiple areas =   
sub/antial improvem5t ( em]g5cy m$ical  
s]vices provid$ 9 ! field1 includ+      
recomm5dations 9 ! ,,ems ,ag5da = !     
,future ( ! ,national ,highway ,traffic 
,safety ,adm9i/ration & ! ,heal?        
,res\rces & ,s]vices ,adm9i/ration1 !   
,in/itute ( ,m$ic9e report ,! ,future ( 
,em]g5cy ,c>e 9 ! ,unit$ ,/ates ,heal?  
,sy/em1 & ! ,,ems ,education ,ag5da = ! 
,future3 ,a ,sy/ems ,approa*1 &         
recomm5dations ( ! ,national ,,ems      
,work=ce ,injury & ,illness             
,surveillance ,program1 ! ,national     

,,ems ,advisory ,c\ncil ( ! ,dep>tm5t ( 
,transportation1 & ! ,f$]al ,int]ag5cy  
,committee on ,em]g5cy ,m$ical ,s]vices4
  7#aj7 ,to sub/antially improve field  
,,ems1 advancem5ts mu/ be made 9 sev]al 
ess5tial areas includ+ read9ess1        
innovation1 prep>$ness1 education &     
work=ce developm5t1 safety1 f9anc+1     
quality1 /&>ds1 & rese>*4  7#aa7 ,!     
recognition ( a prim>y programmatic     
,f$]al ag5cy = em]g5cy m$ical s]vices )9
 ! ,dep>tm5t ( ,heal? & ,human ,s]vices 
0 recomm5d$ by ! ,in/itute ( ,m$ic9e &  
is necess>y to provide a m /reaml9$1    
co/-effici5t1 & compreh5sive approa* =  
field ,,ems & a focal po9t =            
practition]s & ag5cies to int]face ) !  
,f$]al ,gov]nm5t4  7#ab7 ,! ess5tial    
role ( field ,,ems 9 disa/] prep>$ness &
 response mu/ be incorporat$ into !     
national prep>$ness & response /rategy &
 implem5tation z provid$ & ov]se5 by !  
,dep>tm5t ( ,homel& ,security & !       
,dep>tm5t ( ,heal? & ,human ,s]vices    
pursuant to _! respective jurisdictions4

  7#ac7 ,! ess5tial role ( ! ,national  
,highway ,traffic ,safety ,adm9i/ration 
9 ! cont9u$ developm5t ( ! ,national    
,,ems ,in=mation ,sy/em & 9 ov]see+     
transportation issues relat$ to field   
,,ems su* z ,,ems & ambulance vehicle   
safety /&>ds %\ld be ma9ta9$4  7#ad7 ,! 
,f$]al ,int]ag5cy ,committee on ,em]g5cy
 ,m$ical ,s]vices mu/ cont9ue 9 its     
ess5tial role 9 coord9at+ ! ,f$]al      
activities relat$ to ! full spectrum (  
,,ems4  #c4  ,recognition ( ,,hhs z     
prim>y ,f$]al ag5cy = em]g5cy m$ical    
s]vices & trauma c>e ,title ,,xxviii ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #cjj;hh et seq47 is am5d$ by  
add+ at ! end ! foll[+3  ,d ,(fice (    
,,ems & ,trauma  #bhca4 ,recognition (  
,,hhs z prim>y ,f$]al ag5cy = em]g5cy   
m$ical s]vices & trauma c>e2 e/abli%m5t 
( ,(fice ( ,,ems & ,trauma  7a7  ,prim>y
 ,f$]al ag5cy  ,! ,dep>tm5t ( ,heal? &  
,human ,s]vices %all s]ve z ! prim>y    
,f$]al ag5cy ) responsibility = programs
 & activities relat+ to em]g5cy m$ical  

s]vices & trauma c>e4  7b7  ,(fice (    
,,ems & ,trauma  7#a7  ,e/abli%m5t  ,!re
 is e/abli%$ )9 ! ,dep>tm5t ( ,heal? &  
,human ,s]vices an ,(fice ( ,em]g5cy    
,m$ical ,s]vices & ,trauma1 also to be  
kn[n z ! ,(fice ( ,,ems & ,trauma4 ,!   
,(fice ( ,,ems & ,trauma %all be head$  
by a director appo9t$ by ! ,secret>y    
7ref]r$ to 9 ?is section z ! ,director74
  7#b7  ,role ( ,(fice )9 ,,hhs  7,a7   
,9 g5]al  ,! ,(fice ( ,,ems & ,trauma   
%all h--  7i7 ! responsibilities        
delegat$ to ! ,(fice ( ,,ems & ,trauma  
pursuant to p>agraph 7#c72 &  7ii7 su*  
responsibilities & au?orities z may be  
delegat$ or transf]r$ to ! ,(fice (     
,,ems & ,trauma pursuant to subp>agraph 
7,b74  7,b7  ,additional                
responsibilities & au?orities  ,9       
addition to ! responsibilities &        
au?orities specifi$ 9 subp>agraph 7,a71 
! ,secret>y may delegate or transf] to !
 ,(fice ( ,,ems & ,trauma any o!r       
responsibility or au?ority ( ! ,dep>tm5t
 ( ,heal? & ,human ,s]vices relat+ to   

em]g5cy m$ical s]vices & trauma c>e     
7except t ! ,secret>y may n delegate or 
transf] su* responsibilities or         
au?orities t are o!rwise grant$ to a    
specific ag5cy )9 ! ,dep>tm5t 9 /atute71
 includ+ su* s]vices & c>e relat+ to--  
7i7 ! full cont9uum ( em]g5cy m$ical    
s]vices1 includ+ field ,,ems & trauma & 
hospital em]g5cy m$ical c>e2 &  7ii7    
improv+ ! quality1 innovation1 or co/   
effectiv5ess ( em]g5cy m$ical s]vices4  
7,c7  ,location ( (fice 9 ,,hhs  ,!     
,secret>y %all locate ! ,(fice ( ,,ems &
 ,trauma )9 ! organizational /ructure ( 
! ,dep>tm5t ( ,heal? & ,human ,s]vices 9
 a mann] t a*ieves ea* ( ! foll[+3  7i7 
,recognition ( ! importance & unique    
life-sav+ s]vices associat$ ) field     
,,ems1 trauma c>e1 & hospital em]g5cy   
c>e z a significant ,f$]al priority4    
7ii7 ,integration ( ! ess5tial s]vices  
describ$ 9 clause 7i7 ) ! l>g] heal? c>e
 sy/em & )9 ! disa/] prep>$ness sy/em1  
includ+ ?r\gh regionalization ( su*     
s]vices & by enhanc+ daily read9ess     

capabilities to ensure adequate disa/]  
read9ess capabilities1 consi/5t ) !     
,national ,heal? ,security ,/rategy4    
7iii7 ,consolidation1 co-location1 & co/
 effici5cies 9 adm9i/]+ programs &      
activities relat$ to field ,,ems1 trauma
 c>e1 & hospital em]g5cy m$ical c>e4    
7iv7 ,e/abli%m5t ( a ,f$]al focal po9t =
 lead]%ip & improv$ coord9ation1        
support1 & ov]sight ( field ,,ems1      
trauma c>e1 & hospital em]g5cy m$ical   
c>e4  7v7 ,suffici5t level & /ature su* 
t--  7,i7 su* ,(fice is able to fulfill 
its role1 responsibilities1 &           
au?orities2 &  7,,ii7 ! ,director ( su* 
,(fice reports directly to ! ,secret>y  
or an (ficial )9 ! ,dep>tm5t :o reports 
directly to ! ,secret>y4  7vi7          
,e/abli%m5t ( a visible & id5tifiable   
po9t ( contact ) :i* ! public2 ,,ems    
ag5cies & practition]s2 ,/ate & local   
gov]nm5t ag5cies2 ,,ems educational     
in/itutions2 ,,ems1 trauma1 & hospital  
em]g5cy c>e pr(essional associations2 & 
all o!r p>ties may int]act4  7#c7       

,responsibilities  ,! ,secret>y %all1 at
 a m9imum1 delegate responsibility to ! 
,(fice ( ,,ems & ,trauma to c>ry out    
section #ccj;,j & p>ts ,a1 ,b1 ,c1 ,d1  
,h1 & ,i 7except subsection 7c77#a7 (   
section #abid7 ( title ,,xii4  7c7      
,national ,,ems /rategy  ,! ,secret>y1  
act+ ?r\gh ! ,director1 & 9 consultation
 ) ! ,assi/ant ,secret>y = ,prep>$ness &
 ,response & ! ,adm9i/rator ( ! ,heal?  
,res\rces & ,s]vices ,adm9i/ration1 %all
 develop & implem5t a cohesive national 
,,ems /rategy to /r5g!n ! developm5t ( !
 full cont9uum ( ,,ems at ! ,f$]al1     
,/ate1 & local levels4 ,9 e/abli%+ su* a
 /rategy1 ! ,secret>y %all--  7#a7      
solicit & consid] ! recomm5dations ( !  
,national ,em]g5cy ,m$ical ,s]vices     
,advisory ,c\ncil z well z relevant     
/akehold]s2  7#b7 consult & collaborate 
) ! ,f$]al ,int]ag5cy ,committee on     
,em]g5cy ,m$ical ,s]vices to ensure     
consi/5cy ( su* national ,,ems /rategy  
)9 ! l>g] ,f$]al /rategy reg>d+ all (   
em]g5cy m$ical s]vices & national       

prep>$ness & response2  7#c7 address    
issues relat$ to ,,ems pati5t &         
practition] safety1 /&>dization ( ,,ems 
practition] lic5s+ & cr$5tial+1 field   
,,ems quality & m$ical ov]sight1        
regionalization ( field ,,ems & trauma &
 em]g5cy c>e s]vices1 availability (    
field ,,ems & trauma c>e & em]g5cy      
m$ical s]vices ?r\gh\t ! ,nation1 &     
integration ( field ,,ems practition]s  
into ! broad] heal? c>e sy/em1 includ+--
  7,a7 promotion ( ! adoption by ,/ates 
( ! education /&>ds id5tifi$ 9 !        
,em]g5cy ,m$ical ,s]vices ,education    
,ag5da = ! ,future3 ,a ,sy/ems ,approa* 
& any revisions !reto1 includ+ !        
/&>dization ( lic5s+ & cr$5tial+ ( field
 ,,ems practition]s & /&>ds ( c>e1 bas$ 
on be/ practices & evid5ce-bas$ m$ic9e1 
includ+ by--  7i7 ! id5tification (     
diff]5ces 9 ! levels ( c>e1 scope (     
practice1 & lic5sure & cr$5tial+        
requirem5ts among ! ,/ates2 &  7ii7 !   
adoption by ! ,/ates ( national /&>ds = 
su* levels ( c>e1 scope ( practice &    

lic5sure & cr$5tial+ requirem5ts2  7,b7 
promotion ( a culture ( safety1         
includ+--  7i7 ! adoption ( an anonym\s 
error report+ sy/em design$ to id5tify  
sy/emic problems 9 field ,,ems pati5t & 
practition] safety & ensure a s+le means
 ( collect+ & report+ relevant error    
data by field ,,ems ag5cies & ,/ates2   
7ii7 ! e/abli%m5t ( field ,,ems pati5t &
 practition] safety goals & ! specific  
means to improve field ,,ems practition]
 & pati5t safety to a*ieve su* goals2 & 
7iii7 ! adoption ( m uni=m national     
ambulance vehicle safety & manufactur+  
/&>ds z develop$ by ! ,national ,fire   
,protection ,adm9i/ration or coord9at$  
by ! ,national ,highway ,traffic ,safety
 ,adm9i/ration2  7,c7 ! integration &   
utilization ( field ,,ems practition]s z
 "p ( ! l>g] heal? c>e sy/em1 includ+-- 
7i7 ! pot5tial utilization ( field ,,ems
 practition]s = ! provision ( c>e to    
pati5ts ) nonem]g5t m$ical conditions1  
su* z ?r\gh mobile integrat$ heal? c>e  
s]vices or community p>am$ic9e2 &  7ii7 

/rategies to implem5t ! recomm5dations  
provid$ by ! ,national ,heal? ,c>e      
,work=ce ,commission1 pursuant to       
section #eaja7;d77#b7 ( ! ,pati5t       
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #bidq7d77#b772 &  7,d7 su* o!r
 issues z ! ,secret>y consid]s          
appropriate2  7#d7 incorporate into su* 
/rategy ! prep>$ness & response         
objectives id5tifi$ by ! ,secret>y (    
,homel& ,security & ! ,assi/ant         
,secret>y = ,prep>$ness & ,response 9   
ord]--  7,a7 to ensure ! capability &   
capacity ( ! full spectrum ( ,,ems to   
respond to t]rori/ attacks1 disa/]s1    
cata/rophic ev5ts1 & mass casualty      
ev5ts2 &  7,b7 to coord9ate ) !         
,secret>y ( ,homel& ,security accord+ly2
  7#e7 complete ! developm5t ( su*      
/rategy n lat] ?an #ah mon?s aft] ! date
 ( enactm5t ( ?is ,act2  7#f7           
communicate su* /rategy to ! relevant   
congressional committees ( jurisdiction2
  7#g7 implem5t su* /rategy1 to ! ext5t 
practicable1 n lat] ?an #c ye>s aft] !  

date ( enactm5t ( ! ,field ,,ems        
,innovation ,act2 &  7#h7 update su*    
/rategy n less ?an e #c ye>s4  7d7      
,def9itions ,9 ?is section1 ! t]ms field
 ,,ems1 em]g5cy m$ical s]vices1 & m$ical
 ov]sight h ! mean+ giv5 su* t]ms 9     
section #abia4  4  #d4 ,em]g5cy m$ical  
s]vices ,title ,,xii ( ! ,public ,heal? 
,s]vice ,act 7#db ,u4,s4,c4 #cjj;d et   
seq47 is am5d$ by add+ at ! end !       
foll[+3  ,i ,em]g5cy m$ical s]vices     
#abia4 ,def9itions ,9 ?is "p3  7#a7 ,!  
t]m ambulance div]sion means ! practice 
( hospitals ( d5y+ access to an incom+  
ambulance & reque/+ t ! ambulance proce$
 to ano!r facility due to a /at$ lack ( 
capacity at ! initial facility1 result+ 
9 delay$ access to def9itive c>e4  7#b7 
,! t]m ,director means ! ,director ( !  
,(fice ( ,,ems & ,trauma e/abli%$ "u    
section #bhca4  7#c7 ,! t]m ,,ems means 
em]g5cy m$ical s]vices4  7#d7 ,! t]m    
,,ficems means ! ,f$]al ,int]ag5cy      
,committee on ,em]g5cy ,m$ical ,s]vices4
  7#e7 ,! t]m field ,,ems means em]g5cy 

m$ical s]vices provid$ to pati5ts       
7includ+ transport by gr\nd1 air1 or    
o!rwise7 prior to or outside a m$ical   
facility or o!r cl9ical sett+4  7#f7 ,! 
t]m field ,,ems ag5cy means an          
organization provid+ field ,,ems1       
includ+--  7,a7 gov]nm5tal 7includ+     
fire-bas$ ag5cies71 nongov]nm5tal       
7includ+ hospital-bas$ or private       
ag5cies71 & volunte] organizations2 &   
7,b7 organizations t provide field ,,ems
 by gr\nd1 air1 or o!rwise4  7#g7 ,! t]m
 em]g5cy m$ical s]vices or ,,ems means  
em]g5cy m$ical c>e1 trauma c>e1 & relat$
 s]vices provid$ to pati5ts at any po9t 
9 ! cont9uum ( heal? c>e s]vices1       
includ+ em]g5cy m$ical dispat* & em]g5cy
 m$ical c>e1 trauma c>e1 & relat$       
s]vices provid$ 9 ! field1 dur+         
transport1 or 9 a m$ical facility or o!r
 cl9ical sett+4  7#h7 ,! t]m field ,,ems
 pati5t c>e reports means ! in=mation t 
a field ,,ems ag5cy typically creates   
reg>d+ a pati5t's m$ical condition &    
treatm5t 9 ! c\rse ( provid+ em]g5cy    

m$ical s]vices to t pati5t4  7#i7 ,! t]m
 m$ical ov]sight means ! sup]vision by a
 physician ( ! m$ical aspects ( an ,,ems
 sy/em or ag5cy & its provid]s1 includ+ 
prospective1 concurr5t1 & respective    
compon5ts ( field ,,ems & ! education ( 
,,ems provid]s4  7#aj7 ,! t]m ,,nemsac  
means ! ,national ,em]g5cy ,m$ical      
,s]vices ,advisory ,c\ncil4  7#aa7 ,!   
t]m ,,nemsis means ! ,national ,,ems    
,in=mation ,sy/em4  7#ab7 ,! t]m ,,nhtsa
 means ! ,national ,highway ,traffic    
,safety ,adm9i/ration4  7#ac7 ,! t]m    
pati5t p>k+ means ! practice by         
hospitals ( refus+ to accept transf] ( a
 pati5t's c>e f an ambulance crew until 
a regul> em]g5cy dep>tm5t b$ is         
available1 requir+ ! crew to cont9ue to 
provide pati5t c>e on ! ambulance /ret*]
 r ?an 9 a pati5t b$ 9 ! hospital1 until
 hospital /aff w accept ! transf] ( c>e1
 result+ 9 delay$ access to def9itive   
c>e4  7#ad7 ,! t]m ,/ate ,,ems ,(fice   
means an (fice designat$ by ! ,/ate )   
prim>y responsibility = ov]sight ( !    

,/ate's ,,ems sy/em1 su* z              
responsibility = ov]sight ( ,,ems       
coord9ation1 lic5s+ or c]tify+ ,,ems    
practition]s1 & ,,ems sy/em improvem5t4 
7#ae7 ,! t]m ,,/emi means ,,/-,segm5t   
,elevation ,myoc>dial ,inf>ction4       
#abib4  ,field ,,ems ,excell5ce1        
,quality1 ,univ]sal ,access1            
,innovation1 & ,prep>$ness  7a7  ,9     
g5]al  ,! ,director %all e/abli% ! an   
,,ems ,excell5ce1 ,quality1 ,univ]sal   
,access1 ,innovation1 & ,prep>$ness     
grant program1 to be ref]r$ to z !      
,,equip grant program--  7#a7 to promote
 excell5ce 9 all aspects ( ! provision (
 field ,,ems by field ,,ems ag5cies2    
7#b7 to enhance ! quality ( em]g5cy     
m$ical c>e provid$ to pati5ts by field  
,,ems practition]s ?r\gh evid5ce-bas$1  
m$ically direct$ field em]g5cy c>e2     
7#c7 to promote univ]sal access to &    
availability ( high-quality field ,,ems 
9 all geographic locations ( ! ,nation2 
7#d7 to spur innovation 9 ! deliv]y (   
field ,,ems2 &  7#e7 to improve ,,ems   

ag5cy read9ess & prep>$ness = day-to-day
 em]g5cy m$ical response4  7b7          
,application  7#a7  ,9 g5]al  ,to be    
eligible to receive a grant "u ?is      
section1 an eligible entity %all submit 
an application to ! ,director 9 su* =m &
 mann]1 & conta9+ su* agreem5ts1        
assurances1 & in=mation z ! ,director   
det]m9es to be necess>y to c>ry out ?is 
section4  7#b7  ,simple =m  ,! ,director
 %all ensure t grant application        
requirem5ts are n unduly burd5some to   
small] & volunte] field ,,ems ag5cies or
 o!r ag5cies ) limit$ res\rces4  7#c7   
,consi/5cy ) prep>ation goals  ,!       
,director %all ensure t grant           
applications are consi/5t ) national &  
relevant ,/ate prep>$ness plans & goals4
  7c7  ,use ( funds  ,grants may be us$ 
by eligible entities--  7#a7 to su/a9   
field ,,ems practition]s to ensure #bd  
h\rs a day1 #g days a week read9ess &   
prep>$ness at ! local level2  7#b7 to   
develop & implem5t initiatives relat$ to
 deliv]y ( m$ical s]vices1 includ+--    

7,a7 innovative cl9ical practices to    
improve ! co/ effectiv5ess & quality (  
c>e deliv]$ to em]g5cy pati5ts 9 ! field
 t results 9 improv$ pati5t outcomes &  
co/ sav+s to ! heal? sy/em1 includ+ =   
high preval5ce em]g5cy m$ical conditions
 su* z sudd5 c>diac arre/1 ,,/emi1      
/roke1 & trauma2 &  7,b7 deliv]y sy/ems 
to improve pati5t outcomes1 :i* may     
include implem5t+ evid5ce-bas$          
protocols1 int]v5tions1 sy/ems1 &       
te*nologies to r$uce cl9ically mean+ful 
response times2  7#c7 to pur*ase &      
implem5t--  7,a7 m$ical equipm5t & tra9+
 = us+ su* equipm5t2  7,b7 communication
 sy/ems to ensure seamless & int]op]able
 communications ) o!r fir/ respond]s2 & 
7,c7 in=mation sy/ems to comply )       
,,nemsis data collection & integrate    
field em]g5cy c>e ) electronic m$ical   
records2  7#d7 to p>ticipate 9 f$]ally  
sponsor$ field ,,ems rese>*2  7#e7 to   
e/abli% or enhance compreh5sive m$ical  
ov]sight & quality assurance programs t 
include ! active p>ticipation by m$ical 

directors 9 field ,,ems m$ical direction
 & educational programs2 &  7#f7 = su*  
o!r uses z ! ,director det]m9es         
appropriate4  7d7  ,adm9i/ration (      
grants  ,9 e/abli%+ & adm9i/]+ ! ,,equip
 grant program1 ! ,director--  7#a7 %all
 e/abli% a grantmak+ process t          
includes--  7,a7 prioritization = !     
aw>d+ ( grants to eligible entities &   
consid]ation ( ! factors 9 review+ grant
 applications by eligible entities1     
includ+--  7i7 demon/rat$ f9ancial ne$ =
 fund+2  7ii7 utilization ( public &    
private p>tn]%ips2  7iii7 enhanc$ access
 to high-quality field ,,ems 9 "u s]v$  
geographic areas2  7iv7 unique ne$s (   
volunte] & rural field ,,ems ag5cies2   
7v7 di/ribution among a v>iety (        
geographic areas1 includ+ urban1        
suburban1 & rural2  7vi7 di/ribution (  
funds among types ( ,,ems ag5cies1      
includ+ gov]nm5tal1 nongov]nm5tal &     
volunte]2  7vii7 implem5tation (        
evid5ce-bas$ int]v5tions t improve      
quality ( c>e1 pati5t outcomes1         

effici5cy1 or co/ effectiv5ess2 &       
7viii7 su* o!r factors z ! ,director    
det]m9es necess>y2  7,b7 a pe]-review$  
process to recomm5d grant allocations 9 
accordance ) ! prioritization e/abli%$  
by ! ,director1 except t f9al aw>d      
det]m9ations %all be made by !          
,director2 &  7,c7 ! provision ( grant  
aw>ds to eligible entities on an annual 
basis1 except t ! ,director may res]ve n
 m ?an #be p]c5t ( ! available          
appropriations = multiye> grants & no   
grant aw>d may exce$ a #b-ye> p]iod2    
7#b7 %all consult ) & take into         
consid]ation ! recomm5dations ( !       
,assi/ant ,secret>y = ,prep>$ness &     
,response1 ,,ficems1 ,,nemsac1 &        
relevant /akehold]s2  7#c7 %all ensure t
 funds us$ = day-to-day prep>$ness      
activities are consi/5t & align$ )      
,f$]al prep>$ness priorities2 &  7#d7   
may contract ) an indep5d5t1 ?ird-p>ty1 
nonpr(it organization to adm9i/] ! grant
 program if ! ,director e/abli%es       
conflict-(-int]e/ requirem5ts z "p ( any

 su* contractual relation%ip4  7e7      
,eligibility  ,eligible grant recipi5ts 
are field ,,ems ag5cies t--  7#a7 are   
lic5s$ by or o!rwise au?oriz$ 9 ! ,/ate 
9 :i* !y op]ate2 &  7#b7 h m$ical       
ov]sight & quality improvem5t programs z
 def9$ by ! ,director4  7f7  ,requir$   
use ( guidel9es ,z a condition on       
receipt ( a grant "u ?is section1 !     
,director %all require ! grant recipi5t 
to adopt & implem5t 7to ! ext5t         
applicable7 ! guidel9es promot$1        
develop$1 & dissem9at$ "u subp>agraphs  
7,b7 & 7,c7 ( section #abid7;a77#a74    
7g7 ,annual report  ,! ,director %all   
submit an annual report on ! ,,equip    
grant program "u ?is section to         
,congress4  #abic4  ,field ,,ems ,sy/em 
,p]=mance1 ,integration1 &              
,acc\ntability  7a7  ,9 g5]al  ,!       
,director %all e/abli% a ,field ,,ems   
,sy/em ,p]=mance1 ,integration1 &       
,acc\ntability grant program1 to be     
ref]r$ to z ! ,,spia grant program--    
7#a7 to improve field ,,ems sy/em       

p]=mance1 integration1 & acc\ntability2 
7#b7 to ensure prep>$ness = field ,,ems 
at ! ,/ate & local levels2  7#c7 to     
enhance physician m$ical ov]sight (     
field ,,ems sy/ems2  7#d7 to improve    
coord9ation betwe5 regional field ,,ems 
sy/ems & integration ( su* regional     
field ,,ems sy/ems into ! l>g] heal? c>e
 sy/em2  7#e7 to enhance data collection
 & analysis to improve1 on a cont9u+    
basis1 ! field ,,ems sy/em2 &  7#f7 to  
promote /&>dization ( national ,,ems    
c]tification ( em]g5cy m$ical te*nicians
 & p>am$ics4  7b7  ,use ( funds         
,entities receiv+ grants "u ?is section 
may use su* grant funds--  7#a7 to      
enhance ,,ems sy/em read9ess &          
prep>$ness = day-to-day em]g5cy m$ical  
response2  7#b7 to improve cross-bord]  
collaboration & plann+ among ,/ates2 &  
7#c7 to collect data ) reg>d to--  7,a7 
,,nemsis2  7,b7 field ,,ems education2  
7,c7 field ,,ems work=ce2  7,d7 c>diac  
ev5ts1 includ+ ,,/emi & sudd5 c>diac    
arre/2  7,e7 /roke2  7,f7 disa/]s1      

includ+ injuries & illnesses2  7,g7     
ambulance div]sion & pati5t p>k+2  7,h7 
trauma 79 a mann] t is complem5t>y & n  
duplicative ( o!r trauma data           
collection1 su* z ! ,national ,trauma   
,data ,bank72  7,i7 data det]m9$        
necess>y by ! ,/ate (fice ( ,,ems =     
ov]sight & coord9ation ( ! ,/ate field  
,,ems sy/em2 &  7,j7 any o!r su* data t 
! ,director specifies2  7#d7 to implem5t
 & evaluate sy/em-wide quality          
improvem5t initiatives1 includ+ m$ical  
direction at ! ,/ate1 local1 & regional 
levels2  7#e7 to integrate field ,,ems )
 o!r heal? c>e s]vices z "p ( a         
coord9at$ sy/em ( c>e provid$ to pati5ts
 ) em]g5cy m$ical conditions to help    
ensure ! "r pati5t receives ! "r c>e by 
! "r crew 9 ! "r vehicle & at ! "r      
m$ical facility 9 ! "r am\nt ( "t1      
includ+ by enhanc+ regional em]g5cy     
m$ical dispat*2  7#f7 to incorporate    
national ,,ems c]tification = all levels
 ( em]g5cy m$ical te*nicians & p>am$ics2
  7#g7 to improve ! ,/ate's plann+ =    

ensur+ a consi/5t1 available ,,ems      
work=ce2  7#h7 to fund ,,ems regional & 
local ov]sight & plann+ organizations or
 develop regional sy/ems ( em]g5cy      
m$ical c>e )9 ! ,/ate to fur!r enhance  
coord9ation & sy/emic developm5t ?r\gh\t
 ! ,/ate2 &  7#i7 = su* o!r uses z !    
,director det]m9es appropriate4  7c7    
,adm9i/ration ( grants  ,9 e/abli%+ &   
adm9i/]+ ! ,,spia grant program1 !      
,director %all--  7#a7 e/abli% ,/ate    
,,ems sy/em p]=mance /&>ds to s]ve z    
guidance to ,/ates 9 improv+ ,,ems      
sy/ems & 9 apply+ = grants "u ?is       
section1 tak+ into consid]ation--  7,a7 
! recomm5dations ( ! ,assi/ant ,secret>y
 = ,prep>$ness & ,response1 ,,ficems1   
,,nemsac1 & relevant /akehold]s2  7,b7  
national1 evid5ce-bas$ guidel9es2 &     
7,c7 ! ne$s & res\rce limitations (     
volunte]1 small] ag5cies1 & ag5cies 9   
rural areas2  7#b7 provide te*nical     
assi/ance to ,/ate ,,ems (fices 9       
conduct+ compreh5sive ,,ems plann+ )    
reg>d to evid5ce-bas$ work=ce &         

developm5t compet5cies = field ,,ems    
managem5t2  7#c7 allocate1 )9 !         
available funds1 ,,spia grants to a     
maximum ( "o grant p] applicant accord+ 
to a =mula bas$ on population &         
geographic area1 z det]m9$ by !         
,director1 = a p]iod n to exce$ #b ye>s2
 &  7#d7 require t ,/ates allocate a    
portion ( funds aw>d$ "u ?is section to 
regional & local ov]sight & plann+ ,,ems
 organizations )9 ! ,/ate = ! purpose ( 
field ,,ems sy/em developm5t1 ma9t5ance1
 & improvem5t ( coord9ation among       
regional organizations4  7d7            
,application  ,to be eligible to receive
 a grant "u ?is section1 an eligible    
entity %all submit an application to !  
,director 9 su* =m & mann]1 conta9+ su* 
agreem5ts1 assurances1 & in=mation z !  
,director det]m9es to be necess>y to    
c>ry out ?is section4  7e7  ,eligibility
  ,! entities eligible = a grant "u ?is 
section are ! ,/ate ,,ems (fice 9 ea* ( 
! sev]al ,/ates1 ,indian tribes1 &      
t]ritories4  7f7  ,requir$ use (        

guidel9es ,z a condition on receipt ( a 
grant "u ?is section1 ! ,director %all  
require ! grant recipi5t to adopt &     
implem5t 7to ! ext5t applicable7 !      
guidel9es promot$1 develop$1 &          
dissem9at$ "u subp>agraphs 7,b7 & 7,c7 (
 section #abid7;a77#a74  7g7 ,annual    
report  ,! ,director %all submit an     
annual report on ! ,,spia grant program 
"u ?is section to ,congress4  #abid4    
,field ,,ems quality  7a7  ,m$ical      
ov]sight  7#a7  ,9 g5]al  ,to improve   
m$ical ov]sight ( field ,,ems & ensure  
cont9uity & quality = su* m$ical        
ov]sight1 ! ,director %all--  7,a7      
promote high-quality & compreh5sive     
m$ical ov]sight (--  7i7 all m$ical c>e 
provid$ by field ,,ems practition]s2 &  
7ii7 ! education & tra9+ ( field ,,ems  
practition]s2  7,b7 promote !           
developm5t1 adoption1 & utilization (   
national guidel9es = ! roles (          
physicians :o provide m$ical ov]sight = 
field ,,ems & o!r heal? c>e provid]s :o 
support physicians 9 ?is role2  7,c7    

support ef=ts ( relevant physician      
/akehold]s 9 develop+ & dissem9at+      
guidel9es = use by ,,ems m$ical         
directors & field ,,ems practition]s on 
a national basis2 &  7,d7 conv5e a      
,field ,,ems ,m$ical ,ov]sight ,advisory
 ,committee1 compris$ ( repres5tatives (
 relevant physician /akehold]s1 to      
advise ! ,director on ways & means to   
advance & support developm5t & ma9t5ance
 ( quality m$ical ov]sight ?r\gh\t !    
,nation's sy/ems = field ,,ems4  7#b7   
,additional consid]ations  ,9 c>ry+ out 
subp>agraphs 7,b7 & 7,c7 ( p>agraph     
7#a71 ! ,director %all take into        
consid]ation--  7,a7 exi/+ guidel9es    
develop$ by national pr(essional        
physician associations1 ,/ates1 & o!r   
relevant gov]nm5tal or nongov]nm5tal    
entities2  7,b7 ! input ( o!r relevant  
/akehold]s1 includ+ heal? c>e provid]s  
:o support physicians :o provide m$ical 
ov]sight = field ,,ems2 &  7,c7 ! unique
 ne$s associat$ ) m$ical ov]sight (     
provision ( field ,,ems 9 rural areas or

 by volunte]s4  7#c7  ,flexibility  ,!  
guidel9es promot$1 develop$1 &          
dissem9at$ "u subp>agraphs 7,b7 & 7,c7 (
 p>agraph 7#a7 %all ensure high-quality 
tra9+1 cr$5tial+1 & direction 9         
connection ) m$ical ov]sight ( field    
,,ems at ! ,/ate1 regional1 & local     
levels :ile provid+ suffici5t           
flexibility to acc\nt = hi/orical &     
legitimate diff]5ces 9 field ,,ems among
 ,/ates1 regions1 & localities4  7b7    
,,gao /udy & report  7#a7  ,9 g5]al  ,! 
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all complete a /udy on--  7,a7 m$ical &
 adm9i/rative liability issues t may    
imp$e--  7i7 m$ical direction provid$ by
 physicians directly reg>d+ specific    
pati5ts or m$ical ov]sight provid$ by   
physicians 9 e/abli%+ m$ical protocols1 
proc$ures1 & o!r activities relat$ to ! 
provision ( em]g5cy m$ical c>e 9 field  
,,ems2 or  7ii7 ! highe/ quality em]g5cy
 m$ical c>e 9 field ,,ems provid$ by    
p]sonnel o!r ?an physicians su* z       
em]g5cy m$ical te*nicians & p>am$ics2   

7,b7 reimbursem5t = any compon5t (      
m$ical ov]sight2 &  7,c7 su* o!r issues 
z ! ,comptroll] ,g5]al det]m9es         
appropriate relat+ to improv+ ! quality 
& m$ical ov]sight ( em]g5cy m$ical c>e 9
 field ,,ems4  7#b7  ,report to         
,congress  ,n lat] ?an #ah mon?s aft] ! 
date ( ! enactm5t ( ! ,field ,,ems      
,innovation ,act1 ! ,comptroll] ,g5]al  
%all complete ! /udy "u p>agraph 7#a7 & 
submit a report to ,congress on !       
results ( su* /udy1 includ+ any         
recomm5dations4  7c7  ,data collection &
 ex*ange  7#a7  ,national ,,ems         
in=mation sy/em  7,a7  ,9 g5]al  ,!     
,adm9i/rator ( ,,nhtsa may ma9ta91      
improve1 & exp& ! ,national ,,ems       
,in=mation ,sy/em1 includ+ ! ,national  
,,ems ,database4  7,b7  ,consultation   
,! ,adm9i/rator ( ,,nhtsa %all c>ry out 
?is p>agraph 9 consultation ) !         
,director4  7,c7  ,/&>dization  ,9 c>ry+
 out subp>agraph 7,a71 ! ,adm9i/rator ( 
,,nhtsa %all promote ! collection &     
report+ ( data on field ,,ems 9 a       

/&>diz$ mann]4  7,d7  ,availability (   
data  ,! ,adm9i/rator ( ,,nhtsa %all    
ensure t in=mation 9 ! ,national ,,ems  
,database 7o!r ?an individually         
id5tifiable in=mation7 is available to  
,f$]al & ,/ate policymak]s1 ,,ems       
/akehold]s1 & rese>*]s4  7,e7  ,te*nical
 assi/ance  ,9 c>ry+ out subp>agraph    
7,a71 ! ,adm9i/rator ( ,,nhtsa may      
provide te*nical assi/ance to ,/ate &   
local ag5cies1 field ,,ems ag5cies1 &   
o!r entities1 z ! ,adm9i/rator det]m9es 
appropriate1 to assi/ 9 ! collection1   
analysis1 & report+ ( data4  7#b7       
,report on data gaps  7,a7  ,9 g5]al  ,n
 lat] ?an #a ye> aft] ! date ( !        
enactm5t ( ! ,field ,,ems ,innovation   
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices1 act+ ?r\gh ! ,director1 9     
consultation ) ! ,adm9i/rator ( ,,nhtsa1
 %all submit to ,congress a report t--  
7i7 id5tifies gaps 9 ! collection ( data
 relat$ to ! provision ( field ,,ems2 & 
7ii7 includes recomm5dations = improv+ !
 collection1 report+1 & analysis ( su*  

data4  7,b7  ,recomm5dations  ,!        
recomm5dations requir$ by subp>agraph   
7,a77ii7 %all--  7i7 take into          
consid]ation ! recomm5dations ( ,,ficems
 & ,,nemsac & relevant /akehold]s2  7ii7
 recomm5d me?ods = improv+ data         
collection & report+ & analysis )\t     
unduly burd5+ report+ entities & )\t    
duplicat+ exi/+ data s\rces 7su* z data 
collect$ by ! ,national ,trauma ,data   
,bank72  7iii7 address ! quality &      
availability ( data1 & l9kages ) exi/+  
pati5t regi/ries1 relat$ to ! provision 
( field ,,ems & utilization ( field     
,,ems ) respect to a v>iety ( illnesses 
& injuries 79 bo? ! ev]yday provision ( 
field ,,ems & cata/rophic or disa/]     
response71 includ+--  7,i7 c>diac ev5ts 
su* z *e/ pa91 sudd5 c>diac arre/1 &    
,,/emi2  7,,ii7 /roke2  7,,iii7 trauma2 
7,,iv7 disa/] & cata/rophic incid5ts1   
su* z incid5ts relat$ to t]rorism or    
natural or manmade disa/]s2 &  7,v7     
ambulance div]sion & pati5t p>k+2 &     
7iv7 include an analysis ( ! v>iety (   

s]vices provid$ by field ,,ems ag5cies4 
7#c7  ,report on data integration to    
promote quality ( c>e  ,n lat] ?an #ah  
mon?s aft] ! date ( enactm5t ( ! ,field 
,,ems ,innovation ,act1 ! ,secret>y1    
act+ ?r\gh ! head ( ! ,(fice ( !        
,national ,coord9ator = ,heal?          
,in=mation ,te*nology & ! ,director1 9  
collaboration ) ,,ficems & !            
,adm9i/rator ( ,,nhtsa z appropriate1 & 
tak+ into consid]ation input f relevant 
/akehold]s1 %all submit a report        
7includ+ recomm5dations7 on issues1     
imp$im5ts1 & pot5tial solutions p]ta9+  
to ! foll[+ objectives3  7,a7           
,incorporation ( field ,,ems pati5t c>e 
reports into pati5t electronic heal?    
records1 tak+ into consid]ation--  7i7 !
 ext5t to :i* field ,,ems pati5t c>e    
reports are creat$ 9 electronic =mat & !
 pot5tial = elem5ts ( su* reports to be 
incorporat$ into pati5t electronic heal?
 records2  7ii7 ! data elem5ts ( field  
,,ems pati5t c>e reports t w\ld promote 
quality & effici5cy ( c>e if incorporat$

 into pati5t electronic heal? records2  
7iii7 pot5tial modifications to !       
,m$ic>e & ,m$icaid programs "u titles   
,,xviii & ,,xix1 respectively1 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq41 #acif et seq47 or o!r    
,f$]al heal? programs 7includ+ pot5tial 
modifications to ! ,,hite* ,act 7title  
,,xiii ( division ,a & title ,,iv (     
,division ,b ( ,public ,law #aaa-e71    
includ+ modifications to ! entities     
includ$ z eligible = inc5tive paym5ts "u
 section #ahdh7o71 #ahec7l7 7to ! ext5t 
t su* section #ahdh7o7 is appli$71 or   
#aijc7t7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciew-#d7o71 #aciew-#bc7l71 
#acif;b7t771 crit]ia = c]tifi$ ,,ehr    
te*nology = purposes ( su* sections1 &  
objectives & measures = det]m9+ mean+ful
 use ( su* te*nology = purposes ( su*   
sections7 to provide appropriate        
reimbursem5t & f9ancial inc5tives =     
,,ems ag5cies--  7,i7 to ma9ta9 field   
,,ems pati5t c>e reports 9 a /ructur$   
electronic =mat2 &  7,,ii7 to o!rwise   

adopt & use electronic heal? records2 & 
7iv7 pot5tial modifications to ! ,,hite*
 ,act to provide inc5tives to eligible  
hospitals "u section #ahhf7n71 #ahec7m7 
7to ! ext5t t su* section #ahhf7n7 is   
appli$71 or section #ahad7l77#c7 ( !    
,social ,security ,act to incorporate   
appropriate data elem5ts ( field ,,ems  
pati5t c>e reports into pati5t          
electronic heal? records4  7,b7         
,incorporation ( pati5t heal? in=mation 
creat$ subsequ5t to ! receipt ( field   
,,ems em]g5cy c>e into ,,nemsis1 tak+   
into consid]ation--  7i7 ! types (      
m$ical in=mation creat$ subsequ5t to !  
receipt ( field ,,ems em]g5cy c>e 7su* z
 outcomes in=mation or in=mation reg>d+ 
subsequ5t c>e & treatm5t7 t w\ld1 if    
includ$ 9 ,,nemsis1 be pot5tially useful
 9 evaluat+ & improv+ ! quality ( ,,ems 
c>e2  7ii7 h[ be/ to integrate su*      
in=mation into ,,nemsis2  7iii7 pot5tial
 modifications to ! ,,hite* ,act to     
require eligible hospitals1 z def9$ 9   
section #ahhf7n77#f77;,b7 ( ! ,social   

,security ,act 7#db ,u4,s4,c4           
#acieww7n77#f77;,b771 = purposes (      
inc5tive paym5ts "u                     
#ahhf7;b77#c77;,b77ix7 & #ahhf7n7 ( su* 
,act1 to develop or report relevant data
 to ,,nemsis or o!r appropriate ,/ate or
 private regi/ries2 &  7iv7 pot5tial    
modifications to ! ,m$ic>e & ,m$icaid   
programs "u titles ,,xviii & ,,xix1     
respectively1 ( ! ,social ,security ,act
 or o!r ,f$]al heal? programs to provide
 appropriate reimbursem5t & f9ancial    
inc5tives = field ,,ems ag5cies to      
develop or report relevant data to      
,,nemsis or o!r appropriate ,/ate or    
private regi/ries4  7d7  ,cl>ification (
 ,,hipaa  7#a7  ,ex*ange ( in=mation    
relat$ to ! treatm5t ( pati5ts  7,a7  ,9
 g5]al  ,no?+ 9 ,,hipaa privacy &       
security law 7z def9$ 9 section         
#cjji7;a77#b77 %all be con/ru$ z        
prohibit+ ! ex*ange ( in=mation betwe5  
field ,,ems practition]s treat+ an      
individual & p]sonnel ( a hospital to   
:i* ! individual is transport$ = !      

purposes ( relat+ in=mation on ! m$ical 
hi/ory1 treatm5t1 c>e1 & outcome ( su*  
individual 7includ+ any heal? c>e       
p]sonnel safety issues su* z infecti\s  
disease74  7,b7  ,guidel9es  ,!         
,secret>y %all e/abli% guidel9es =      
ex*anges ( in=mation betwe5 field ,,ems 
practition]s treat+ an individual &     
p]sonnel ( a hospital to :i* !          
individual is transport$ to protect !   
privacy ( ! individual :ile ensur+ !    
ability ( su* ,,ems practition]s &      
hospital p]sonnel to communicate        
effectively to fur!r ! cont9uity &      
quality ( em]g5cy m$ical c>e provid$ to 
su* individual4  7#b7  ,,nemsis data    
,no?+ 9 ,,hipaa privacy & security law  
7z def9$ 9 section #cjji7;a77#b77 %all  
be con/ru$ z prohibit+--  7,a7 a field  
,,ems ag5cy f submitt+ ,,ems data to !  
,/ate ,,ems ,(fice = ! purpose ( quality
 improvem5t & data collection by ! ,/ate
 = submission to ,,nemsis2 or  7,b7 !   
,/ate ,,ems ,(fice f submitt+ aggregat$ 
non9dividually id5tifiable ,,ems data to

 ! ,national ,,ems ,database ma9ta9$ by 
,,nhtsa4  #abie4  ,field ,,ems education
 grants  7a7  ,9 g5]al  ,= ! purpose (  
promot+ field ,,ems z a heal? pr(ession 
& ensur+ ! availability1 quality1 &     
capability ( field ,,ems educators1     
practition]s1 & m$ical directors1 !     
,director may make grants to eligible   
entities = ! developm5t1 availability1 &
 dissem9ation ( field ,,ems education   
programs & c\rses t improve ! quality & 
capability ( field ,,ems p]sonnel4 ,9   
c>ry+ out ?is section1 ! ,director %all 
take into consid]ation recomm5dations ( 
! ,adm9i/rators ( ea* ( ,,nhtsa1        
,,ficems1 & ,,nemsac1 ! ,national ,heal?
 ,c>e ,work=ce ,commission e/abli%$ "u  
section #eaja ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#bidq71 & relevant /akehold]s4  7b7     
,eligibility  ,9 ?is section1 ! t]m     
eligible entity means an educational    
organization1 an educational in/itution1
 a pr(essional association1 & any o!r   
entity involv$ ) ! education ( field    

,,ems practition]s4  7c7  ,use ( funds  
,! ,director may aw>d a grant to an     
eligible entity "u p>agraph 7#a7 only if
 ! entity agrees to use ! grant to--    
7#a7 develop & implem5t education       
programs t--  7,a7 tra9 field ,,ems     
tra9]s & promote ! adoption &           
implem5tation ( ! education /&>ds       
id5tifi$ 9 ! ,em]g5cy ,m$ical ,s]vices  
,education ,ag5da = ! ,future3 ,a       
,sy/ems ,approa* includ+ any revisions  
!reto2  7,b7 bridge ! gap 9 k & skills 9
 field ,,ems & among field ,,ems & o!r  
alli$ heal? pr(essions to develop a l>g]
 cadre ( educational in/ructors & build 
a /rong] & m flexible field ,,ems       
practition] corps2 or  7,c7 provide     
tra9+ & retra9+ programs to provide     
displac$ work]s ! opportunity to ent] a 
field ,,ems pr(ession2  7#b7 develop &  
implem5t educational c\rses p]ta9+ to-- 
7,a7 in/ructor c\rses2  7,b7 provision (
 m$ical direction ( field ,,ems2  7,c7  
field ,,ems practition]s1 includ+       
physicians1 em]g5cy m$ical te*nicians1  

p>am$ics1 nurses1 & o!r relevant        
cl9icians provid+ em]g5cy m$ical c>e 9 !
 field2  7,d7 field ,,ems educational & 
cl9ical rese>*2  7,e7 bridge programs   
among field ,,ems1 nurs+1 & o!r alli$   
heal? pr(essions2  7,f7 field ,,ems     
managem5t2  7,g7 national1 evid5ce-bas$ 
guidel9es2 &  7,h7 translation ( !      
lessons le>n$ 9 milit>y m$ic9e to field 
,,ems2  7#c7 evaluate education & tra9+ 
c\rses & me?odologies to id5tify optimal
 educational modalities = field ,,ems   
practition]s2  7#d7 improve ! field     
,,ems education infra/ructure by        
increas+ ! numb] ( field ,,ems          
in/ructors & ! quality ( _! prep>ation  
by improv+1 enhanc+1 & mod]niz+ !       
dissem9ation ( ,,ems education1 includ+ 
di/ance le>n+1 & by e/abli%+ quality    
improvem5t = ,,ems education programs2  
7#e7 enhance ! opportunity = m$ical     
direction tra9+ & = promot+ appropriate 
m$ical ov]sight ( field em]g5cy m$ical  
c>e2  7#f7 improve sy/ems to design1    
implem5t1 & evaluate education =        

prospective & curr5t field ,,ems        
provid]s2 or  7#g7 c>ry+ out su* o!r    
activities z ! ,director det]m9es       
appropriate4  7d7  ,priority  ,!        
,director1 9 consultation ) ,,nhtsa &   
relevant /akehold]s1 & tak+ into        
consid]ation ! recomm5dations ( ,,ficems
 & ,,nemsac1 %all e/abli% a sy/em (     
prioritization 9 aw>d+ grants "u ?is    
section to eligible entities4  7e7      
,duration ( grants  ,grants "u ?is      
section %all be = a p]iod ( #a to #c    
ye>s4  7f7  ,application  ,! ,director  
may n aw>d a grant to an eligible entity
 "u ?is section unless ! entity submits 
an application to ! ,director 9 su* =m1 
9 su* mann]1 & conta9+ su* agreem5ts1   
assurances1 & in=mation z ! ,director   
may require4 ,! ,director %all ensure t 
! requirem5ts = submitt+ an application 
"u ?is section are n unduly burd5some4  
#abif4  ,evaluat+ innovative models =   
access & deliv]y ( field ,,ems = pati5ts
  7a7  ,evaluation  7#a7  ,9 g5]al  ,n  
lat] ?an #a ye> aft] ! date ( ! enactm5t

 ( ! ,field ,,ems ,innovation ,act1 !   
,director1 9 consultation ) !           
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 & tak+ into          
consid]ation ! recomm5dations ( ,,nemsac
 & ,,ficems1 %all complete an evaluation
 (--  7,a7 ! provision ( & reimbursem5t 
= alt]native deliv]y models = m$ical c>e
 ?r\gh field ,,ems2 &  7,b7 !           
integration ( field ,,ems pati5ts ) o!r 
m$ical provid]s & facilities z m$ically 
appropriate4  7#b7  ,specific issues  ,9
 complet+ ! evaluation "u p>agraph 7#a71
 ! ,director %all consid] ea* ( !       
foll[+3  7,a7 ,alt]native dispositions (
 pati5ts1 includ+--  7i7 transport+     
pati5ts by ambulance to de/9ations o!r  
?an a hospital su* z ! (fice ( !        
pati5t's physician1 an urg5t c>e c5t]1  
or ! facilities ( ano!r heal? c>e       
provid]2  7ii7 :5 m$ically necess>y1 !  
evaluation1 treatm5t1 or ref]ral (      
pati5ts to o!r m$ically appropriate     
heal? c>e provid]s2  7iii7 ! provision (
 m$ical c>e reg>dless ( ! decision to   

transport1 su* z reimbursem5t models    
bas$ on read9ess r ?an transport & %>$  
sav+s2 &  7iv7 ! provision ( heal? c>e  
us+ pati5t c5t]$ mobile res\rces 9 !    
out-(-hospital environm5t1 su* z mobile 
integrat$ heal? c>e s]vices & community 
p>am$ic9e4  7,b7 ,issues relat$ to      
m$ical liability & ! requirem5ts (      
section #ahfg ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;dd2 commonly      
ref]r$ to z ,,emtala7 associat$ )       
transport to de/9ations o!r ?an a       
hospital em]g5cy dep>tm5t4  7,c7        
,necess>y protections to ensure t       
pati5ts receive timely & appropriate c>e
 9 ! appropriate sett+4  7,d7 ,:e!r !re 
are any b>ri]s to provid+ alt]nate      
dispositions to pati5ts :o are n 9 ne$ (
 c>e 9 hospital em]g5cy dep>tm5ts4  7,e7
 ,o!r issues det]m9$ by ! ,director1    
includ+1 :5 practicable1 issues         
recomm5d$ by ,,ficems or ,,nemsac =     
evaluation "u ?is subsection4  7b7      
,demon/ration projects  7#a7  ,9 g5]al  
,beg9n+ n lat] ?an #a ye> aft] ! date ( 

! enactm5t ( ! ,field ,,ems ,innovation 
,act1 ! ,director %all conduct or       
support at lea/ #aj demon/ration        
projects to--  7,a7 evaluate !          
implem5tation & reimbursem5t (          
alt]native dispositions ( field ,,ems   
pati5ts1 includ+--  7i7 transport+      
pati5ts by ambulance to alt]nate        
de/9ations :5 m$ically appropriate & 9 !
 pati5ts' be/ int]e/s2  7ii7 :5 m$ically
 necess>y1 evaluat+1 treat+1 or ref]r+  
pati5ts to o!r m$ically appropriate     
provid]s2 &  7iii7 :5 m$ically          
appropriate1 treat+ pati5ts ?r\gh mobile
 integrat$ heal? c>e s]vices or         
community p>am$ic9e4  7,b7 evaluate !   
implem5tation ( reimbursem5t models bas$
 on read9ess r ?an transport or %>$     
sav+s2 &  7,c7 det]m9e :e!r su*         
alt]native dispositions & reimbursem5t  
models--  7i7 improve ! safety1         
effectiv5ess1 timel9ess1 & effici5cy (  
,,ems2 &  7ii7 r$uce ov]all utilization 
& exp5ditures "u ! ,m$ic>e program "u   
title ,,xviii ( ! ,social ,security     

,act4  7#b7  ,evid5ce-bas$ protocols  ,!
 ,director %all ensure t at lea/ "o     
demon/ration project "u p>agraph 7#a7   
evaluates evid5ce-bas$ protocols t give 
guidance on selection ( ! de/9ation to  
:i* pati5ts are transport$4  7#c7       
,duration  ,! p]iod ( a demon/ration    
project "u p>agraph 7#a7 %all n exce$ #c
 ye>s4  7#d7  ,rese>*  ,! ,director %all
 conduct or support fur!r rese>* t !    
,director det]m9es to be necess>y prior 
to or 9 conjunction ) ! demon/ration    
projects "u ?is subsection 9 ord] to    
evaluation ! implem5tation ( alt]native 
dispositions ( field ,,ems pati5ts4     
7#e7  ,fund+  ,( ! am\nt made available 
to c>ry out section #aaae;,a ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acae;a7 
= a fiscal ye>1 ! ,secret>y may transf] 
su* sums z may be necess>y to c>ry out  
?is subsection4  7c7  ,report to        
,congress  ,n lat] ?an #a ye> aft] !    
completion ( all demon/ration projects  
"u subsection 7b71 ! ,director %all     
submit to ,congress a report on !       

results ( activities "u ?is section1    
includ+ recomm5dations on ! efficacy (  
alt]native dispositions ( field ,,ems   
pati5ts4  4  #e4  ,enhanc+ rese>* 9     
field ,,ems  7a7  ,models ,to be te/$ by
 ,c5t] = ,m$ic>e & ,m$icaid ,innovation 
,section #aaae;,a7b77#b77;,b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7b77#b77;,b77 is am5d$ by add+ at
 ! end ! foll[+3  7xxi7 ,enhanc+ heal?  
outcomes = pati5ts receiv+ field em]g5cy
 m$ical s]vices & improv+ timely &      
effici5t deliv]y ( high-quality field   
em]g5cy m$ical s]vices1 su* z ?r\gh--   
7,i7 regionalization ( em]g5cy c>e2     
7,,ii7 m$ical transport to alt]nate     
de/9ations2 or  7,,iii7 :5 m$ically     
necess>y1 ! evaluation1 treatm5t1 or    
ref]ral ( pati5ts to o!r m$ically       
appropriate heal? provid]s4  4  7b7     
,em]g5cy m$ical rese>*  ,section #dih;,d
 ( ! ,public ,heal? ,s]vice ,act 7#db   
,u4,s4,c4 #bhi;g-#d7 is am5d$--  7#a7 by
 r$esignat+ subsections 7c7 & 7d7 z     
subsections 7d7 & 7e71 respectively2 &  

7#b7 by ins]t+ aft] subsection 7b7 !    
foll[+3  7c7  ,field ,,ems em]g5cy      
m$ical rese>*  7#a7 ,9 g5]al ,!         
,secret>y %all conduct rese>* &         
evaluation relat+ to field ,,ems ?r\gh !
 ,ag5cy = ,heal?c>e ,rese>* & ,quality &
 ! ,c5t] = ,m$ic>e & ,m$icaid           
,innovation4  7#b7 ,def9ition ,9 ?is    
subsection1 ! t]m field ,,ems has !     
mean+ giv5 su* t]m 9 section #abia4  4  
7c7  ,field ,,ems practice c5t]  ,subp>t
 ,,ii ( "p ,d ( title ,,ix ( ! ,public  
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bii;b-#cc et seq47 is am5d$ by add+ at 
! end ! foll[+3  #ich4  ,field ,,ems    
practice c5t]  7a7  ,e/abli%m5t  ,!     
,director %all e/abli% )9 ! ,(fice (    
,rese>* & ,evaluation a ,field ,,ems    
,evid5ce-,bas$ ,practice ,c5t] 7ref]r$  
to 9 ?is section z ! ,c5t]74  7b7       
,purpose  ,! purpose ( ! ,c5t] is to    
conduct or support rese>* to promote !  
highe/ quality ( em]g5cy m$ical c>e 9   
field ,,ems & ! mo/ effective deliv]y   
sy/em = ! provision ( su* c>e1 includ+--

  7#a7 comp>ative safety & effectiv5ess 
rese>*2  7#b7 o!r appropriate cl9ical or
 sy/ems rese>*2 &  7#c7 rese>*          
address+--  7,a7 critical c>e transport2
  7,b7 (f-%ore op]ations2  7,c7 tactical
 em]g5cy m$ical s]vices2  7,d7 air      
m$ical s]vices2 &  7,e7 ! application ( 
lessons le>n$ 9 milit>y field m$ic9e 9 !
 deliv]y ( em]g5cy m$ical c>e 9 field   
,,ems4  7c7  ,def9ition  ,9 ?is section1
 ! t]m field ,,ems has ! mean+ giv5 su* 
t]m 9 section #abia4  4  7d7            
,limitations on c]ta9 uses ( rese>*     
,section #aahb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acbj;e-#a7 is am5d$
 by /rik+ section #aaha ea* place x     
appe>s & ins]t+ section #aaha ( ?is ,act
 or section #dih;,d7c7 or #ich ( !      
,public ,heal? ,s]vice ,act4  7e7       
,regulatory b>ri]s  ,= ! purposes (     
rese>* conduct$ pursuant to clause 7xxi7
 ( section #aaae;,a7b77#b77;,b7 ( !     
,social ,security ,act 7z add$ by       
subsection 7a771 subsection 7c7 (       
section #dih;,d ( ! ,public ,heal?      

,s]vice ,act 7z add$ by subsection 7b771
 section #ich ( ! ,public ,heal? ,s]vice
 ,act 7z add$ by subsection 7c771 or any
 o!r rese>* fund$ by ! ,dep>tm5t (      
,heal? & ,human ,s]vices relat$ to      
em]g5cy m$ical s]vices 9 ! field 9 :i*  
in=m$ cons5t is requir$ b may n be      
atta9able1 ! ,secret>y ( ,heal? & ,human
 ,s]vices %all--  7#a7 evaluate &       
consid] ! pati5t & rese>* issues        
involv$2 &  7#b7 address regulatory     
b>ri]s to su* rese>* relat$ to ! ne$ =  
in=m$ cons5t 9 a mann] t ensures        
adequate pati5t safety & notification1 &
 submit recomm5dations to ,congress =   
any *anges to ,f$]al /atutes necess>y to
 address su* b>ri]s4  #f4  ,em]g5cy     
,m$ical ,s]vices ,tru/ ,fund  7a7       
,designation ( income tax ov]paym5ts &  
additional contributions = em]g5cy      
m$ical s]vices  ,sub*apt] ,a ( *apt] #fa
 ( ! ,int]nal ,rev5ue ,code ( #aihf is  
am5d$ by add+ at ! end ! foll[+ new "p3 
,,ix  ,designation ( income tax         
ov]paym5ts & additional contributions = 

em]g5cy m$ical s]vices  #fjig4          
,designation by individuals  7a7  ,9    
g5]al  ,e individual 7o!r ?an a         
nonresid5t ali57 may designate t--  7#a7
 a specifi$ portion ( any ov]paym5t (   
tax = a taxable ye>1 &  7#b7 any am\nt  
contribut$ 9 addition to any paym5t (   
tax = su* taxable ye> & any designation 
"u p>agraph 7#a71  %all be us$ to fund !
 ,em]g5cy ,m$ical ,s]vices ,tru/ ,fund4 
,designations "u ! prec$+ s5t5ce %all be
 9 an am\nt n less ?an #a1 & ! ,secret>y
 %all provide = elections 9 am\nts ( #a1
 #e1 #aj1 or su* o!r am\nt z ! taxpay]  
designates4  7b7  ,ov]paym5ts ,treat$ z 
,refund$  ,= purposes ( ?is title1 any  
portion ( an ov]paym5t ( tax designat$  
"u subsection 7a7 %all be treat$ z--    
7#a7 be+ refund$ to ! taxpay] z ( ! la/ 
date prescrib$ = fil+ ! return ( tax    
impos$ by *apt] #a 7det]m9$ )\t reg>d to
 ext5sions7 or1 if lat]1 ! date ! return
 is fil$1 &  7#b7 a contribution made by
 su* taxpay] on su* date to ! ,unit$    
,/ates4  7c7  ,mann] & "t ( designation 

,a designation "u subsection 7a7 may be 
made ) respect to any taxable ye>--     
7#a7 at ! "t ( fil+ ! return ( ! tax    
impos$ by *apt] #a = su* taxable ye>1 or
  7#b7 at any o!r "t 7aft] ! "t ( fil+ !
 return ( ! tax impos$ by *apt] #a = su*
 taxable ye>7 specifi$ 9 regulations    
prescrib$ by ! ,secret>y4  ,su*         
designation %all be made 9 su* mann] z !
 ,secret>y prescribes by regulations    
except t1 if su* designation is made at 
! "t ( fil+ ! return ( ! tax impos$ by  
*apt] #a = su* taxable ye>1 su*         
designation %all be made ei!r on ! fir/ 
page ( ! return or on ! page be>+ !     
signature ( ! taxpay]4  4  7b7  ,em]g5cy
 ,m$ical ,s]vices ,tru/ ,fund  ,sub*apt]
 ,a ( *apt] #ih ( ! ,int]nal ,rev5ue    
,code ( #aihf is am5d$ by add+ at ! end 
! foll[+ new section3  #ieab4  ,em]g5cy 
,m$ical ,s]vices ,tru/ ,fund  7a7       
,creation ( tru/ fund  ,!re is e/abli%$ 
9 ! ,treasury ( ! ,unit$ ,/ates a tru/  
fund to be kn[n z ! ,em]g5cy ,m$ical    
,s]vices ,tru/ ,fund1 consi/+ ( su*     

am\nts z may be cr$it$ or paid to su*   
tru/ fund z provid$ 9 subsection 7b74   
7b7  ,transf]s to tru/ fund  ,!re are   
h]eby appropriat$ to ! ,em]g5cy ,m$ical 
,s]vices ,tru/ ,fund am\nts equival5t to
 ! am\nts ( ! ov]paym5ts ( tax to :i*   
designations "u section #fjig apply4    
7c7  ,exp5ditures f tru/ fund  ,am\nts 9
 ! ,em]g5cy ,m$ical ,s]vices ,tru/ ,fund
 %all be available1 z provid$ 9         
appropriation ,acts1 only = c>ry+ out ! 
provisions = :i* am\nts are au?oriz$ to 
be appropriat$ "u subsections 7a7 & 7b7 
( section #g ( ! ,field ,,ems           
,innovation ,act4  4  7c7  ,cl]ical     
am5dm5ts  7#a7  ,cl]ical am5dm5t  ,!    
table ( p>ts = sub*apt] ,a ( *apt] #fa (
 ! ,int]nal ,rev5ue ,code ( #aihf is    
am5d$ by add+ at ! end ! foll[+ new     
item3  ,"p ,,ix4 ,designation ( income  
tax ov]paym5ts & additional             
contributions = em]g5cy m$ical s]vices44
  7#b7 ,! table ( sections = sub*apt] ,a
 ( *apt] #ih ( su* ,code is am5d$ by    
add+ at ! end ! foll[+ new item3  ,sec4 

#ieab4 ,em]g5cy ,m$ical ,s]vices ,tru/  
,fund4  4  7d7 ,effective date ,!       
am5dm5ts made by ?is section %all apply 
to taxable ye>s beg9n+ aft] ,decemb]    
#ca1 #bjae4  #g4  ,au?orization (       
appropriations  7a7  ,9 g5]al  ,out (   
am\nts 9 ! ,em]g5cy ,m$ical ,s]vices    
,tru/ ,fund1 !re are au?oriz$ to be     
transf]r$-- 7#a7 to ! ,secret>y ( ,heal?
 & ,human ,s]vices--  7,a7 #ab1jjj1jjj1 
= ! purpose ( c>ry+ out section #bhca ( 
! ,public ,heal? ,s]vice ,act 7except = 
subsection 7b77#c7 ( su* section71      
section #abid ( su* ,act1 & section     
#abif ( su* ,act 7except = subsection   
7b7 ( su* section7 = ea* ( fiscal ye>s  
#bjae ?r\gh #bjai2  7,b7 #bjj1jjj1jjj = 
ea* ( fiscal ye>s #bjae ?r\gh #bjai1 = !
 purpose ( c>ry+ out section #abib ( !  
,public ,heal? ,s]vice ,act2  7,c7      
#ej1jjj1jjj = ea* ( fiscal ye>s #bjae   
?r\gh #bjai1 = ! purpose ( c>ry+ out    
section #abic ( ! ,public ,heal? ,s]vice
 ,act2  7,d7 #ae1jjj1jjj = ea* ( fiscal 
ye>s #bjae ?r\gh #bjai1 = ! purpose (   

c>ry+ out section #abie ( ! ,public     
,heal? ,s]vice ,act2 &  7,e7 #dj1jjj1jjj
 = ea* ( fiscal ye>s #bjae ?r\gh #bjai1 
= ! purpose ( c>ry+ out sections        
#dih;,d7c7 & #ich ( ! ,public ,heal?    
,s]vice ,act1 z add$ by section #e2 &   
7#b7 to ! ,secret>y ( ,transportation1  
#d1jjj1jjj = ea* ( fiscal ye>s #bjae    
?r\gh #bjai1 = ! purpose ( c>ry+ out    
section #abib7;c77#a7 ( ! ,public ,heal?
 ,s]vice ,act4  7b7  ,excess am\nts     
,if1 = any fiscal ye>1 am\nts 9 !       
,em]g5cy ,m$ical ,s]vices ,tru/ ,fund   
exce$ ! maximum am\nt au?oriz$ to be    
transf]r$ "u subsection 7a71 ! ,secret>y
 ( ,heal? & ,human ,s]vices may transf] 
su* excess am\nts = ! purpose ( c>ry+   
out section #ccj;,j1 section #dih;,d1 & 
p>ts ,a1 ,b1 ,c1 ,d1 & ,h ( title ,,xii 
( ! ,public ,heal? ,s]vice ,act 7#db    
,u4,s4,c4 #bed;c-#ae1 #bhi;g-#d1 #cjj;d 
et seq41 #cjj;d-#aa et seq41 #cjj;d-#ca 
et seq41 & #cjj;d-#ha et seq474  7c7    
,/>t-,up fund+  7#a7  ,9 g5]al  ,out ( !
 discretion>y funds available to !      

,secret>y ( ,heal? & ,human ,s]vices =  
ea* ( fiscal ye>s #bjae & #bjaf1        
#dj1jjj1jjj %all be us$ = c>ry+ out !   
am5dm5ts made by subsections 7a71 7b71 &
 7c7 ( section #e4  7#b7  ,relation to  
o!r funds  ,! am\nt ( discretion>y funds
 allocat$ "u p>agraph 7#a7 = ! purpose (
 c>ry+ out subsections 7a71 7b71 & 7c7 (
 section #e %all be 9 addition to1 n 9  
lieu (1 ! am\nt ( discretion>y funds t  
w\ld o!rwise be available = su* purpose4
  7d7  ,adm9i/rative exp5ses  ,( !      
am\nts made available "u subsection 7a71
 7b71 or 7c7 to c>ry out ea* ( !        
provisions li/$ 9 subsection 7a71 n m   
?an #e p]c5t ( ea* su* am\nt may be us$ 
= ,f$]al adm9i/rative exp5ses4  #h4     
,/atutory con/ruction ,no?+ 9 ?is ,act1 
includ+ ! am5dm5ts made by ?is ,act %all
 be con/ru$ to sup]c$e any /atutory     
au?ority ( any ,f$]al ag5cy t is n )9 ! 
,dep>tm5t ( ,heal? & ,human ,s]vices4