,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #bcff  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjae ,mr4  
,buc%on introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,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  
,mod]nization & ,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 ,align+ ambulance     
reimbursem5t ) value-bas$ & high-quality
 field ,,ems4 ,sec4 #d4 ,field em]g5cy  
m$ical s]vices4 ,sec4 #e4 ,integration (
 field ,,ems into ! ,national ,heal?    
,in=mation ,infra/ructure4 ,sec4 #f4    

,cl>ification ( lead]%ip responsibility 
= r\t9e em]g5cy m$ical c>e4 ,sec4 #g4   
,enhanc+ evid5ce-bas$ c>e 9 field ,,ems4
 ,sec4 #h4 ,em]g5cy m$ical s]vices tru/ 
fund4 ,sec4 #i4 ,,gao /udy to id5tify   
imp$im5ts to quality improvem5t 9 field 
,,ems4 ,sec4 #aj4 ,fund+4 ,sec4 #aa4    
,/atutory con/ruction4  #b4 ,f9d+s      
,congress f9ds ! foll[+3 7#a7 ,pati5ts )
 em]g5cy m$ical conditions dep5d ^u     
field em]g5cy m$ical s]vices 7ref]r$ to 
9 ?is section z ,,ems7 = ess5tial       
life-sav+ or uns*$ul$ m$ical c>e4 ,all p
 9 ! ,unit$ ,/ates %\ld h access to &   
receive high-quality em]g5cy m$ical c>e 
z "p ( a coord9at$ ,,ems sy/em4  7#b7 ,!
 ,in/itute ( ,m$ic9e1 9 its #bjjf report
 ,em]g5cy ,m$ical ,s]vices at !         
,crossroads1 outl9$ its vision ( a #ba/ 
c5tury em]g5cy c>e sy/em t is integrat$1
 regionaliz$1 acc\ntable1 & prep>$ = bo?
 r\t9e em]g5cy m$ical c>e & public heal?
 em]g5cies4 ,su* a mod]niz$ sy/em w\ld  
be *>act]iz$ by a highly tra9$ & capable
 field ,,ems practition] work=ce t      

deliv]s high-quality1 evid5ce-bas$1     
innovative1 value-bas$1 & pati5t-c5t]$  
em]g5cy c>e 9 ! field & across ! em]g5cy
 c>e cont9uum4  7#c7 ,9 su* #bjjf       
report1 ! ,in/itute ( ,m$ic9e also      
outl9$ sy/emic problems plagu+ field    
,,ems t imp$e a*ievem5t ( a #ba/ c5tury 
em]g5cy c>e sy/em1 includ+ insuffici5t  
coord9ation1 disp>ate response times1   
unc]ta9 quality ( c>e1 lack ( read9ess =
 disa/]s1 divid$ pr(essional id5tity (  
field ,,ems practition]s1 & a limit$    
evid5ce base = ! em]g5cy m$ical c>e     
provid$ 9 ! field4  7#d7 ,to mod]nize ! 
field ,,ems sy/em1 ! ,in/itute ( ,m$ic9e
 recomm5d$ t advancem5ts be made 9      
sev]al priority areas1 includ+ read9ess1
 innovation1 prep>$ness1 education &    
work=ce developm5t1 safety1 f9anc+1     
quality1 /&>ds1 & rese>*4 ,! ,in/itutes 
( ,m$ic9e also recomm5d$ recognition ( a
 lead programmatic ,f$]al ag5cy =       
em]g5cy m$ical s]vices )9 ! ,dep>tm5t ( 
,heal? & ,human ,s]vices to provide a m 
/reaml9$1 co/-effici5t1 & compreh5sive  

approa* = field ,,ems1 & a focal po9t = 
practition]s & ag5cies to int]face ) !  
,f$]al ,gov]nm5t4  7#e7 ,"u an am5dm5t  
made by ! ,p&emic & ,all-,haz>ds        
,prep>$ness ,act 7,public ,law          
#aji-dag71 ! ,secret>y ( ,heal? & ,human
 ,s]vices is already e/abli%$ z ! lead (
 all ,f$]al public heal? & m$ical       
response = public heal? em]g5cies &     
incid5ts4 ,prep>$ness & capability to   
deliv] r\t9e em]g5cy m$ical c>e is a    
pr]equisite = prep>$ness & capability to
 respond to public heal? em]g5cies &    
incid5ts4  7#f7 ,9 #bjjg1 ! ,homel&     
,security ,presid5tial ,directive       
,,hspd-#ba call$ = ! e/abli%m5t )9 !    
,dep>tm5t ( ,heal? & ,human ,s]vices (  
an ,(fice = ,em]g5cy ,m$ical ,c>e to    
lead an ent]prise to promote & fund     
rese>* 9 em]g5cy m$ic9e & trauma c>e2   
promote regional p>tn]%ips & m effective
 em]g5cy m$ical sy/ems 9 ord] to enhance
 appropriate triage1 di/ribution1 & c>e 
( r\t9e community pati5ts2 & promote    
local1 regional1 & ,/ate em]g5cy m$ical 

sy/ems' prep>$ness = & response to      
public heal? ev5ts4 ,"u ! ,directive1 ! 
,(fice w\ld address ! full spectrum (   
issues t h an impact on c>e 9 hospital  
em]g5cy dep>tm5ts1 includ+ ! entire     
cont9uum ( pati5t c>e f prehospital to  
disposition f em]g5cy or trauma c>e4    
7#g7 ,prop]ly function+ ,,ems sy/ems    
encompass fully mobile res\rces t are   
able to address pati5t ne$s #bd h\rs p] 
day1 #g days p] week1 #cfe days a ye>4  
,field ,,ems s]ves z an ess5tial heal?  
c>e safety net by provid+ em]g5cy1      
urg5t1 & mobile m$ical c>e ?r\gh\t !    
heal? c>e cont9uum1 includ+ m$ical &    
trauma c>e provid$ 9 ! field1 hospital1 
rehabilitation1 & o!r sett+s4 ,ensur+   
high-quality & co/-effective em]g5cy    
m$ical s]vices sy/ems requires read9ess1
 prep>$ness1 m$ical ov]sight1 &         
innovation ?r\gh\t ! cont9uum ( em]g5cy 
m$ical c>e ?r\gh ,f$]al1 ,/ate1 & local 
multi-jurisdictional collaboration &    
suffici5t res\rces = ,,ems ag5cies &    
practition]s4  7#h7 ,field ,,ems is !   

deliv]y ( heal? c>e1 n simply a         
transportation b5efit hav+ evolv$ f a   
pati5t transport model to a heal? c>e   
s]vice deliv]y model t provides a v>iety
 ( t>get$ m$ical s]vices to meet !      
specific ne$s ( _! communities4 ,?is    
includes ! developm5t ( community       
p>am$ic9e z a heal? c>e s]vice provid$  
by field ,,ems ag5cies & mobile         
integrat$ heal? c>e z a heal? c>e s]vice
 provid$ collaboratively by a gr\p (    
heal? c>e provid]s 9 a community1       
includ+ local field ,,ems ag5cies4 ,^!  
new deliv]y models are fill+ gaps 9     
pati5t c>e id5tifi$ by a community's    
heal? c>e provid]s1 includ+ prev5t+     
recurr5t m$ical episodes ?r\gh reliable 
po/-dis*>ge foll[ up & *ronic disease   
managem5t4 ,facilitat+ reimbursem5t =   
su* s]vices1 includ+ "u ! ,m$ic>e       
program "u title ,,xviii ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie et  
seq471 is necess>y to ! cont9u$         
developm5t & su/a9ability ( su* s]vices4
  7#i7 ,field ,,ems is uniquely         

position$ to support ! trans=mation (   
heal? c>e to a value & outcomes bas$    
model to improve ! pati5t exp]i5ce & !  
heal? ( populations1 & to r$uce ! p]    
capita co/ ( heal? c>e4 ,field ,,ems    
provides highly reliable pati5t         
assessm5t & int]v5tion at any h\r ( any 
day 9 response to urg5t or uns*$ul$     
episodes ( illness or injury &          
effectively navigates pati5ts to ensure 
!y receive ! "r c>e1 9 ! "r place1 & at 
! "r "t4 ,field ,,ems helps conta9 heal?
 c>e co/s by navigat+ ! pati5t d[n a    
co/-effective pa?way t is evid5ce-bas$4 
7#aj7 ,coord9at$ & 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 e  
day & dur+ cata/rophic incid5ts4 ,to    
ensure disa/] & all-haz>ds prep>$ness = 
field ,,ems op]ations z "p ( ! ,nation's
 compreh5sive disa/] prep>$ness1 ,f$]al 
fund+ = prep>$ness activities1 includ+  
cata/rophic tra9+ & ex]cises1 mu/ be    

provid$ to gov]nm5tal & nongov]nm5tal   
field ,,ems ag5cies to ensure a great]  
capability )9 ea* ( ^! areas4  7#aa7 ,! 
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]vices1 pursuant to _!         
respective jurisdictions4 ,field ,,ems  
ag5cies mu/ be capable ( meet+ ! r\t9e  
em]g5cy c>e ne$s ( pati5ts to be capable
 ( meet+ ! extraord9>y m$ical ne$s dur+ 
a cata/rophic ev5t4  #c4 ,align+        
ambulance reimbursem5t ) value-bas$ &   
high-quality field ,,ems  7a7 ,field    
,,ems ,m$ic>e demon/ration program      
,section #aaae;,a7b77#b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#b77 is am5d$-- 7#a7 9 ! la/ 
s5t5ce ( subp>agraph 7,a71 by ins]t+ 1 &
 %all include ! model describ$ 9        
subp>agraph 7,d7 be=e ! p]iod at ! end2 
&  7#b7 by add+ at ! end ! foll[+ new   

subp>agraph3  7,d7 ,demon/ration        
projects  7i7 ,9 g5]al ,! model describ$
 9 ?is subp>agraph is a demon/ration    
program "u title ,,xviii4 ,beg9n+ n lat]
 ?an #b ye>s aft] ! date ( ! enactm5t ( 
! ,field ,,ems ,mod]nization &          
,innovation ,act1 ! ,,cmi %all conduct n
 less ?an #aj demon/ration projects to--
  7,i7 evaluate ! implem5tation &       
reimbursem5t ( alt]native dispositions (
 field ,,ems pati5ts1 includ+--  7aa7   
transport+ individuals by ambulance to  
alt]nate de/9ations :5 m$ically         
appropriate & 9 ! individual's be/      
int]e/s2  7bb7 :5 m$ically necess>y1    
evaluat+1 treat+1 or ref]r+ individuals 
to o!r m$ically appropriate provid]s2 & 
7cc7 :5 m$ically appropriate1 treat+    
individuals ?r\gh community p>am$ic9e or
 mobile integrat$ heal?c>e s]vices2     
7,,ii7 evaluate ! implem5tation (       
alt]native reimbursem5t models1 includ+ 
models bas$ on read9ess r ?an transport 
or %>$ sav+s2 &  7,,iii7 det]m9e :e!r   
su* alt]native dispositions &           

reimbursem5t models-- 7aa7 improve !    
safety1 effectiv5ess1 timel9ess1 &      
effici5cy ( em]g5cy m$ical s]vices2 &   
7bb7 r$uce ov]all utilization &         
exp5ditures "u title ,,xviii4  7ii7     
,evid5ce-bas$ protocols ,! ,,cmi %all   
ensure t at lea/ "o demon/ration project
 "u ?is subp>agraph evaluates           
evid5ce-bas$ protocols t give guidance  
on selection ( ! de/9ation to :i*       
individuals are transport$4  7iii7      
,duration ,! duration ( a demon/ration  
project "u ?is subp>agraph %all n exce$ 
#c ye>s4  7iv7 ,rese>* ,! ,secret>y %all
 conduct or support fur!r rese>* t !    
,secret>y det]m9es to be necess>y prior 
to1 or 9 conjunction )1 ! demon/ration  
projects "u ?is subp>agraph 9 ord] to   
evaluate ! implem5tation ( alt]native   
dispositions (1 & reimbursem5t models = 
transport (1 field ,,ems pati5ts4  7v7  
,report to ,congress ,n lat] ?an #a ye> 
aft] ! completion ( all demon/ration    
projects "u ?is subp>agraph1 ! ,secret>y
 %all include 9 ! annual report to      

,congress requir$ "u subsection 7g7 a   
report on ! results ( ! projects        
conduct$ "u ?is subp>agraph1 includ+    
in=mation ab\t ! efficacy ( alt]native  
disposition (1 & reimbursem5t models =  
transport (1 field ,,ems pati5ts4  7vi7 
,def9ition ( field ,,ems ,9 ?is         
subp>agraph1 ! t]ms community p>am$ic9e1
 field ,,ems1 mobile integrat$ heal?c>e1
 & read9ess %all h ! mean+s giv5 su*    
t]ms 9 section #abia ( ! ,public ,heal? 
,s]vice ,act4  4  7b7 ,field ,,ems      
alt]native deliv]y program ,section     
#ahcd7l7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7l77 is am5d$ by add+  
at ! end ! foll[+ new p>agraph3  7#af7  
,field ,,ems alt]native deliv]y program 
7,a7 ,9 g5]al ,n lat] ?an #c ye>s aft] !
 date ( ! enactm5t ( ?is p>agraph1 !    
,secret>y %all e/abli% ! ,field ,,ems   
,alt]native ,deliv]y ,program to e/abli%
 & promote ! utilization ( innovative   
paym5t models1 includ+ ! models describ$
 9 subp>agraph 7,d71 on a %>$ sav+s &   
volunt>y basis1 tak+ into consid]ation !

 results ( ! evaluation ( models "u     
subp>agraph 7,g7 & ! demon/ration       
projects conduct$ "u section            
#aaae;,a7b77#b77;,d74 ,to ! ext5t t !   
,secret>y asc]ta9s t an innovative      
paym5t model has be5 suffici5tly        
demon/rat$ ?r\gh ! private sector or    
?r\gh ! ,c5t] = ,m$ic>e & ,m$icaid      
,innovation "u section #aaae;,a & does n
 ne$ to be evaluat$ "u subp>agraph 7,g71
 ! ,secret>y may e/abli% su* innovative 
paym5t model on a %>$ sav+s & budget    
neutral basis pursuant to ?is           
subp>agraph4  7,b7 ,volunt>y nature (   
p>ticipation ,provid]s & suppli]s (     
gr\nd ambulance s]vices may volunt>ily  
opt to utilize innovative paym5t models 
"u ! ,field ,,ems ,alt]native ,deliv]y  
,program4 ,no?+ 9 ?is subp>agraph %all  
be con/ru$ z au?oriz+ ! ,secret>y to    
require p>ticipation 9 any innovative   
paym5t model "u ! ,program4  7,c7       
,budget neutrality ,! ,secret>y %all    
implem5t ! innovative paym5t models "u  
?is subp>agraph 9 a budget neutral mann]

 su* t ! co/ ( implem5tation ( su*      
models %all n exce$ ! am\nt t o!rwise   
w\ld h be5 provid$ 9 reimbursem5t "u ?is
 title if su* models _h n be5 implem5t$4
  7,d7 ,types ( models ,! foll[+ models 
are describ$ 9 ?is clause3 7i7          
,community p>am$ic9e t all[s = paym5t = 
heal? c>e assessm5t & prev5tion s]vices1
 or o!r c>e managem5t s]vices4  7ii7    
,mobile integrat$ heal?c>e s]vices t    
all[ = heal? c>e assessm5t & prev5tion  
s]vices1 or o!r c>e managem5t s]vices )9
 an integrat$ program ( pati5t c>e4     
7iii7 ,alt]nate pati5t dispositions     
reg>dless ( transport to ! hospital1    
includ+ transport to alt]nate de/9ations
 & o!r pati5t dispositions su* z treat+ 
& ref]r+ pati5ts to appropriate foll[ up
 c>e4 ,su* alt]nate dispositions1       
includ+ alt]nate de/9ations & treat &   
ref] dispositions1 w\ld be subject to ! 
discretion ( ! physician m$ical director
 responsible = provid+ m$ical ov]sight4 
7iv7 ,! provision ( field ,,ems &       
reimbursem5t on a population heal?      

basis1 su* z ?r\gh global capitation4   
7v7 ,prev5tion-bas$ models1 su* z injury
 prev5tion ?r\gh home evaluations = fall
 prev5tion or infection control4  7vi7  
,critical c>e models1 p>ticul>ly 9      
geographic areas )\t proximate access to
 hospital-bas$ critical c>e1 & includ+ a
 model t enables pati5t /abilization by 
critical c>e transport teams )          
telem$ic9e support = ma9ta9+ ! pati5t 9 
! pati5t's community4  7vii7 ,any o!r   
innovative %>$ sav+s model ! ,secret>y  
det]m9es relevant pursuant to           
subp>agraph 7,g74  7,e7 ,quality report+
 ,z a condition ( p>ticipation 9 !      
,field ,,ems ,alt]native ,deliv]y       
,program1 provid]s & suppli]s ( gr\nd   
ambulance s]vices %all p>ticipate 9 !   
,ambulance ,quality ,inc5tive ,program  
describ$ 9 p>agraph 7#ag74  7,f7 ,m$ical
 ov]sight ,! ,secret>y %all specify &   
require appropriate m$ical ov]sight )   
reg>d to ! developm5t1 demon/ration1 &  
implem5tation ( innovative paym5t models
 "u ?is p>agraph to ensure high-quality 

c>e & pati5t safety4  7,g7 ,developm5t &
 evaluation ( models  7i7 ,9 g5]al ,!   
,secret>y1 9 consultation ) ! ,assi/ant 
,secret>y = ,prep>$ness & ,response &   
tak+ into consid]ation ! recomm5dations 
( ! ,national ,,ems ,advisory ,c\ncil & 
! ,f$]al ,int]ag5cy ,committee on ,,ems1
 %all und]take ! developm5t & evaluation
 ( innovative models ( field ,,ems      
deliv]y & reimbursem5t4  7ii7           
,evaluation ( innovative model options  
7,i7 ,9 g5]al ,n lat] ?an #a ye> aft] ! 
date ( ! enactm5t ( ! ,field ,,ems      
,mod]nization & ,innovation ,act1 !     
,secret>y %all complete an evaluation   
(-- 7aa7 ! provision ( & reimbursem5t = 
alt]native deliv]y models = m$ical c>e  
?r\gh field ,,ems2 &  7bb7 ! integration
 ( field ,,ems pati5ts ) o!r m$ical     
provid]s & facilities z m$ically        
appropriate4  7,,ii7 ,consid]ations ,9  
complet+ ! evaluation "u subclause 7,i71
 ! ,secret>y %all consid] ! foll[+3 7aa7
 ,alt]native dispositions ( pati5ts1    
includ+-- 7,,aa7 transport+ individuals 

by ambulance to de/9ations o!r ?an a    
hospital1 su* z ! (fice ( ! physician ( 
! individual1 an urg5t c>e c5t]1 or !   
facility ( ano!r heal? c>e provid]2     
7,,bb7 :5 m$ically necess>y1 !          
evaluation1 treatm5t1 or ref]ral (      
individuals to o!r m$ically appropriate 
heal? c>e provid]s2 7,,cc7 ! provision (
 m$ical c>e reg>dless ( ! decision to   
transport1 su* z reimbursem5t models    
bas$ on read9ess r ?an transport & %>$  
sav+s2 & 7,,dd7 ! provision ( heal? c>e 
us+ pati5t-c5t]$ mobile res\rces 9 !    
out-(-hospital environm5t1 su* z        
community p>am$ic9e & mobile-integrat$  
heal? c>e s]vices4  7bb7 ,issues relat$ 
to m$ical liability & ! requirem5ts (   
section #ahfg 7commonly ref]r$ to z     
,,emtala7 associat$ ) transport to      
de/9ations o!r ?an a hospital em]g5cy   
dep>tm5t4  7cc7 ,necess>y protections to
 ensure t pati5ts receive timely &      
appropriate c>e 9 ! appropriate sett+1  
includ+ ongo+ quality improvem5t &      
appropriate physician m$ical ov]sight4  

7dd7 ,:e!r !re are any b>ri]s to provid+
 alt]nate dispositions to individuals :o
 are n 9 ne$ ( hospital-bas$ c>e4  7ee7 
,o!r reimbursem5t relat$ issues t span  
multiple deliv]y models includ+ ! co/ ( 
demon/rat$ evid5ce-bas$ c>e1 su* z      
#ab-lead electroc>diograms & cont9u\s   
positive airway pressure1 e>ly          
recognition ( "t dep5d5t diseases1 su* z
 /roke & sepsis1 & trauma1 & provid+    
high-quality appropriate physician      
m$ical ov]sight4  7ff7 ,o!r issues1 z   
det]m9$ by ! ,secret>y1 includ+1 :5     
practicable1 issues recomm5d$ by !      
,assi/ant ,secret>y = ,prep>$ness &     
,response1 ! ,national ,,ems ,advisory  
,c\ncil1 & ! ,f$]al ,int]ag5cy          
,committee on ,,ems = evaluation "u ?is 
subp>agraph4  7,h7 ,def9itions ,9 ?is   
p>agraph1 ! t]ms community p>am$ic9e1   
field ,,ems1 m$ical ov]sight1 & mobile  
integrat$ heal?c>e h ! mean+s giv5 su*  
t]ms 9 section #abia ( ! ,public ,heal? 
,s]vice ,act4  4  7c7 ,ambulance quality
 inc5tive program ,section #ahcd7l7 ( ! 

,social ,security ,act 7#db ,u4,s4,c4   
#aciem7l771 z am5d$ by subsection 7a71  
is fur!r am5d$ by add+ at ! end ! foll[+
 new p>agraph3  7#ag7 ,ambulance quality
 inc5tive program  7,a7 ,9 g5]al ,n lat]
 ?an ,janu>y #a ( ! fir/ fiscal ye> t   
beg9s on or aft] ! date t is #c ye>s    
aft] ! date ( ! enactm5t ( ?is p>agraph1
 ! ,secret>y %all e/abli% an ,ambulance 
,quality ,inc5tive ,program "u :i*      
provid]s & suppli]s ( gr\nd ambulance   
s]vices "u ?is subsection may receive   
inc5tive paym5ts f ! am\nt made         
available "u subp>agraph 7,f7 = report+ 
on ! quality measures id5tifi$ by !     
,secret>y "u subp>agraph 7,b74  7,b7    
,quality measures  7i7 ,9 g5]al ,!      
,secret>y %all1 by regulation1 id5tify  
quality measures t h be5 endors$ by !   
entity ) a contract "u section          
#ahij7;a74 ,su* measures %all include   
outcome & pati5t safety measures & be   
relevant to ! provision ( field em]g5cy 
m$ical response & mobile m$ical c>e4    
7ii7 ,exception ,9 ! case ( a specifi$  

area or m$ical topic det]m9$ appropriate
 by ! ,secret>y = :i* a feasible &      
practical measure has n be5 endors$ by !
 entity ) a contract "u section         
#ahij7;a71 ! ,secret>y may specify a    
measure t is n s endors$ z long z due   
consid]ation is giv5 to measures t h be5
 endors$ or adopt$ by a cons5sus        
organization id5tifi$ by ! ,secret>y4   
7iii7 ,revis+ quality measures ,subject 
to clause 7iv71 ! ,secret>y may1 by     
regulation1 revise quality measures     
id5tifi$ "u ?is p>agraph on an annual   
basis4  7iv7 ,timeframe ,! ,secret>y    
%all publi% ! quality measures t w apply
 to a fiscal ye> n lat] ?an ,janu>y #a (
 ! prec$+ fiscal ye>4  7,c7 ,volunt>y   
nature ( report+ ,p>ticipation 9 !      
,ambulance ,quality ,inc5tive ,program  
is volunt>y = provid]s & suppli]s elect+
 n to p>ticipate 9 ! ,field ,,ems       
,alt]native ,deliv]y ,program4  7,d7    
,consultation ,9 c>ry+ out ! provisions 
( ?is p>agraph 7includ+ 9 develop+ &    
revis+ ! quality measures id5tifi$ 9    

subp>agraph 7,b771 ! ,secret>y %all--   
7i7 solicit ! input ( relevant          
/akehold]s2  7ii7 use ! notice & comm5t 
proc$ures provid$ 9 section #eec ( title
 #e1 ,unit$ ,/ates ,code2 &  7iii7 take 
into acc\nt prior inve/m5ts 9 te*nology 
sy/ems to enable p>ticipation 9 !       
program ) m9imal additional capital     
inve/m5ts4  7,e7 ,public availability ( 
data submitt$ ,! ,secret>y %all e/abli% 
proc$ures = mak+ data submitt$ "u ?is   
p>agraph available to ! public on !     
website ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices4 ,su* proc$ures %all ensure t a
 suppli] or provid] has ! opportunity to
 review ! data t is to be made public ) 
respect to ! suppli] or provid] prior to
 su* data be+ made public4  7,f7 ,budget
 neutral fund+  7i7 ,9 g5]al ,! am\nt   
available = mak+ paym5ts "u ?is p>agraph
 = any fiscal ye> %all be equal to !    
am\nt ( sav+s = ! prec$+ fiscal ye>     
result+ f ! ,field ,,ems ,alt]native    
,deliv]y ,program describ$ 9 p>agraph   
7#af71 z det]m9$ by ! ,secret>y4  7ii7  

,priority = p>ticipants 9 ,field ,,ems  
,alt]native ,deliv]y program ,to ! ext5t
 t funds are available = mak+ paym5ts "u
 ?is p>agraph = a fiscal ye>1 !         
,secret>y %all ensure t--  7,i7 provid]s
 & suppli]s :o p>ticipat$ 9 ! program   
e/abli%$ "u p>agraph 7#af7 9 ! prec$+   
fiscal ye> are paid be=e o!r provid]s & 
suppli]s2 &  7,,ii7 provid]s & suppli]s 
:o did n p>ticipate 9 ! program e/abli%$
 "u p>agraph 7#af7 9 ! prec$+ fiscal ye>
 may only receive paym5ts if !re are any
 funds rema9+ aft] ! application (      
subclause 7,i74  4  #d4 ,field em]g5cy  
m$ical s]vices  7a7 ,9 g5]al ,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 ,field   
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 community p>am$ic9e means a heal?
 c>e s]vice provid$ by a field ,,ems    
ag5cy = ! provision ( co/-effective     
heal? c>e assessm5t & prev5tion s]vices 
to fill gaps 9 ! local heal? c>e sy/em4 
7#c7 ,! t]m em]g5cy m$ical response     
means-- 7,a7 m$ical c>e provid$ to      
pati5ts ) em]g5cy m$ical conditions     
prior to or outside a m$ical facility2  
7,b7 em]g5cy m$ical dispat*1 rapid      
response1 & urg5t or uns*$ul$ pati5t    
assessm5t & int]v5tion2  7,c7 em]g5cy1  
critical c>e1 & int]-facility & air     
m$ical transport2 or  7,d7 telephone    
consultation to #iaa call]s z an        
alt]native to ambulance dispat*1 or o!r 
reque/s ?r\gh a public safety answ]+    
po9t4  7#d7 ,! t]m em]g5cy m$ical       
s]vices 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$ical facility 
or o!r cl9ical sett+4  7#e7 ,! t]m      
,,ficems means ! ,f$]al ,int]ag5cy      
,committee on ,em]g5cy ,m$ical ,s]vices4
  7#f7 ,! t]m field ,,ems means em]g5cy 
m$ical response & mobile m$ical s]vices 
provid$ prior to or outside a m$ical    
facility4  7#g7 ,! t]m field ,,ems ag5cy
 means an organization provid+ field    
,,ems1 includ+-- 7,a7 gov]nm5tal        
7includ+ fire-bas$ 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#h7 ,! t]m field ,,ems       
practition] means an individual lic5s$ &
 cr$5tial$ to provide em]g5cy & mobile  
m$ical c>e to pati5ts )9 ! scope ( su*  
individual's practice4  7#i7 ,! t]m     
m$ical ov]sight means ! sup]vision by a 
physician ( ! m$ical aspects ( a field  
,,ems sy/em or ag5cy & its practition]s1
 includ+ prospective1 concurr5t1 &      
respective compon5ts ( field ,,ems & !  

education ( field ,,ems practition]s4   
7#aj7 ,! t]m mobile integrat$ heal? c>e 
means a heal? c>e s]vice t is und]tak5  
collaboratively by a gr\p ( heal? c>e   
provid]s1 includ+ ! local field ,,ems   
ag5cy1 9 a community1 = ! provision (   
m$ical c>e to fill gaps 9 ! local heal? 
c>e sy/em4  7#aa7 ,! t]m mobile m$ical  
s]vices means prev5tive m$ical assessm5t
 & c>e1 *ronic disease assessm5t &      
managem5t support1 po/-dis*>ge foll[-up 
assessm5t & managem5t support1 &        
po/-assessm5t pati5t transport1 arrang$ 
transportation1 or ref]ral to o!r       
community heal? or social s]vice        
res\rces4  7#ab7 ,! t]m ,,nemsac means !
 ,national ,em]g5cy ,m$ical ,s]vices    
,advisory ,c\ncil4  7#ac7 ,! t]m        
,,nemsis means ! ,national ,,ems        
,in=mation ,sy/em4  7#ad7 ,! t]m ,,nhtsa
 means ! ,national ,highway ,traffic    
,safety ,adm9i/ration4  7#ae7 ,! 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>e = ! pati5t & d5i$ access to em]g5cy 
c>e = ! community s]v$ by ! field ,,ems 
,ag5cy4  7#af7 ,! t]m read9ess means !  
/&by co/s ( prep>$ness to respond to a  
heal? c>e ne$1 #bd h\rs a day1 #g days a
 week1 #cfe days a ye>4  7#ag7 ,! t]m   
,/ate ,,ems ,(fice means an (fice       
designat$ by ! ,/ate ) prim>y           
responsibility = ov]sight ( ! ,/ate's   
em]g5cy m$ical s]vices sy/em1 su* z     
responsibility = ov]sight ( field ,,ems 
coord9ation1 lic5s+ or c]tify+ field    
,,ems practition]s1 & em]g5cy m$ical    
s]vices sy/em improvem5t4  #abib4 ,field
 ,,ems prep>$ness = public heal?        
em]g5cies & o!r incid5ts  7a7 ,9 g5]al  
,! ,assi/ant ,secret>y = ,prep>$ness &  
,response %all e/abli% ! ,field ,,ems   
,prep>$ness ,program to be adm9i/]$ by !

 ,(fice ( ,em]g5cy ,m$ical ,c>e = !     
purpose ( improv+ field ,,ems ag5cy     
all-haz>ds read9ess & prep>$ness &      
public heal? em]g5cies & incid5ts4  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 ! ,assi/ant ,secret>y 
= ,prep>$ness & ,response 9 su* =m &    
mann]1 & conta9+ su* agreem5ts1         
assurances1 & in=mation z su* ,assi/ant 
,secret>y requires4  7#b7 ,simple =m ,! 
,assi/ant ,secret>y = ,prep>$ness &     
,response %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 ,! ,assi/ant ,secret>y =          
,prep>$ness & ,response %all ensure t   
grant applications are consi/5t )       
national & relevant ,/ate prep>$ness    
plans & goals4  7c7 ,use ( funds ,grants
 may be us$ by eligible entities to     
a*ieve ! prep>$ness goals describ$ "u   

p>agraphs 7#a71 7#c71 7#d71 7#e71 7#f71 
& 7#h7 ( section #bhjb7;b7 ) respect to 
all-haz>ds1 includ+ *emical1 biological1
 radiological1 or nucle> ?reats1 includ+
 ! pur*ase ( equipm5t1 tra9+1 &         
supplies4  7d7 ,adm9i/ration ( grants ,9
 c>ry+ out ?is section1 ! ,assi/ant     
,secret>y = ,prep>$ness & ,response--   
7#a7 %all e/abli% a grantmak+ process t 
includes--  7,a7 prioritization = !     
aw>d+ ( grants to eligible entities &   
consid]ation ( ! factors 9 review+ grant
 applications by eligible entities1     
includ+--  7i7 demon/rat$ f9ancial ne$ =
 fund+2  7ii7 utilization ( public &    
private p>tn]%ips2  7iii7 improv+ !     
availability ( field ,,ems 9 und]s]v$   
regions to enhance ! capability = m$ical
 response to public heal? em]g5cies &   
incid5ts2  7iv7 unique ne$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 (
 field ,,ems ag5cies1 includ+           

gov]nm5tal1 nongov]nm5tal1 & volunte]   
ag5cies2  7vii7 implem5tation (         
regionaliz$ sy/ems ( m$ical response to 
public heal? em]g5cies & incid5ts2 &    
7viii7 su* o!r factors z ! ,assi/ant    
,secret>y = ,prep>$ness & ,response     
det]m9es necess>y2  7,b7 a pe]-review$  
process to recomm5d grant allocations 9 
accordance ) ! prioritization e/abli%$  
"u subp>agraph 7,a71 except t f9al aw>d 
det]m9ations %all be made by ! ,assi/ant
 ,secret>y = ,prep>$ness & ,response2 & 
7,c7 ! provision ( grant aw>ds to       
eligible entities on an annual basis1   
except t ! ,assi/ant ,secret>y =        
,prep>$ness & ,response 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 ( !       
,,ficems1 ,,nemsac1 & relevant          
/akehold]s4  7e7 ,eligibility ,to be    
eligible to receive a grant "u ?is      
section1 an entity %all be a field ,,ems

 ag5cy t-- 7#a7 is lic5s$ by or o!rwise 
au?oriz$ 9 ! ,/ate 9 :i* x op]ates2 &   
7#b7 has m$ical ov]sight & quality      
improvem5t programs1 z det]m9$ by !     
,assi/ant ,secret>y = ,prep>$ness &     
,response4  7f7 ,requir$ use ( m$ical   
ov]sight guidel9es ,z a condition on    
receipt ( a grant "u ?is section1 !     
,assi/ant ,secret>y = ,prep>$ness &     
,response %all require ea* grant        
recipi5t to adopt & implem5t 7to ! ext5t
 applicable7 ! guidel9es promot$1       
develop$1 & dissem9at$ "u subp>agraphs  
7,b7 & 7,c7 ( subsection 7a77#a7 (      
section #abic ) reg>d to m$ical         
ov]sight4  7g7 ,annual report ,!        
,assi/ant ,secret>y = ,prep>$ness &     
,response %all submit an annual report  
on ! ,field ,,ems ,prep>$ness ,program  
"u ?is section to ,congress4  #abic4    
,field ,,ems quality improvem5t  7a7    
,enhanc+ physician m$ical ov]sight  7#a7
 ,9 g5]al ,to improve m$ical ov]sight ( 
field ,,ems & ensure cont9uity & quality
 = su* m$ical ov]sight1 ! ,assi/ant     

,secret>y = ,prep>$ness & ,response     
%all--  7,a7 promote high-quality &     
compreh5sive m$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 = !    
role ( physicians :o provide m$ical     
ov]sight = field ,,ems & o!r heal? c>e  
provid]s :o support physicians 9 su*    
role2  7,c7 support ef=ts ( relevant    
physician /akehold]s 9 develop+ &       
dissem9at+ guidel9es = use by field     
,,ems m$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 ! ,assi/ant       
,secret>y = ,prep>$ness & ,response on  
ways & means to advance & support       
developm5t & ma9t5ance ( quality m$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 ! ,assi/ant
 ,secret>y = ,prep>$ness & ,response    
%all take into consid]ation--  7,a7     
exi/+ guidel9es develop$ 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    
,pati5t safety improvem5t ,field ,,ems  

ag5cies & practition]s %all be eligible 
to p>ticipate 9 ! activities ( pati5t   
safety organizations = ! purpose (      
improv+ pati5t safety & ! quality (     
heal? c>e deliv]y4  7c7 ,analysis (     
,data ,gaps ,t ,h9d] ,high-,quality     
,field ,,ems ,c>e  7#a7 ,9 g5]al ,n lat]
 ?an #a ye> aft] ! date ( ! enactm5t ( !
 ,field ,,ems ,mod]nization &           
,innovation ,act1 ! ,secret>y1 act+     
?r\gh ! ,assi/ant ,secret>y =           
,prep>$ness & ,response1 %all submit to 
,congress a report t--  7,a7 id5tifies  
gaps 9 ! collection ( data relat$ to !  
provision ( field ,,ems2 &  7,b7        
includes recomm5dations = improv+ !     
collection1 report+1 & analysis ( su*   
data1 & integration ( su* data ) o!r    
heal? c>e data4  7#b7 ,recomm5dations ,!
 recomm5dations includ$ 9 ! report 9    
accordance ) p>agraph 7#a77;,b7 %all--  
7,a7 take into consid]ation !           
recomm5dations ( ,,ficems1 ,,nemsac1 &  
relevant /akehold]s2  7,b7 recomm5d     
me?ods = improv+ data collection1       

report+1 & analysis )\t unduly burd5+   
report+ entities & )\t duplicat+ exi/+  
data s\rces 7su* z data collect$ by !   
,national ,trauma ,data ,bank72  7,c7   
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+--  7i7 c>diac ev5ts su* z *e/   
pa91 sudd5 c>diac arre/1 & ,,/-segm5t   
elevation myoc>dial inf>ction2  7ii7    
/roke2  7iii7 trauma2  7iv7 disa/] &    
cata/rophic incid5ts1 su* z incid5ts    
relat$ to t]rorism or natural or manmade
 disa/]s2 &  7v7 ambulance div]sion &   
pati5t p>k+2  7,d7 include an analysis (
 ! v>iety ( s]vices provid$ by field    
,,ems ag5cies2 &  7,e7 any              
recomm5dations t require /atutory       
au?orization f ,congress4  7#c7         
,implem5tation ( recomm5dations ) exi/+ 
/atutory au?ority ,! ,secret>y1 act+    

?r\gh ! ,(fice ( ! ,national ,coord9ator
 = ,heal? ,in=mation ,te*nology1 %all   
implem5t su* recomm5dations = data      
collection to ! ext5t t su* au?ority    
exi/s & does n require fur!r /atutory   
au?orization f ,congress4  #abid4       
,acc\ntability = field ,,ems sy/em      
p]=mance  7a7 ,developm5t ( field ,,ems 
quality & sy/em p]=mance measures ,!    
,assi/ant ,secret>y = ,prep>$ness &     
,response %all support-- 7#a7 fur!r     
developm5t & ref9em5t ( measures to be  
utiliz$ "u ! ,ambulance ,quality        
,inc5tive ,program1 z appropriate1      
includ+--  7,a7 quality measures to     
improve acc\ntability = pati5t outcomes 
9 field ,,ems2 &  7,b7 p]=mance measures
 to enhance ! measurem5t ( field ,,ems  
sy/em p]=mance2 &  7#b7 a te*nical      
assi/ance c5t] to provide assi/ance &   
education to field ,,ems ag5cies1       
physician m$ical directors1 &           
practition]s to p>ticipate effectively 9
 quality & p]=mance improvem5t programs4
  7b7 ,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 has be5 treat$ = ! purposes (
 relat+ in=mation on ! m$ical hi/ory1   
treatm5t1 c>e1 & outcome ( su*          
individual 7includ+ any heal? c>e       
p]sonnel safety issues1 su* z infecti\s 
disease74  7,b7 ,guidel9es ,! ,secret>y 
%all e/abli% guidel9es = ex*anges (     
in=mation betwe5 field ,,ems            
practition]s treat+ an individual &     
p]sonnel ( a hospital to :i* !          
individual has be5 treat$ to protect !  
privacy ( ! individual :ile ensur+ !    
ability ( su* field ,,ems practition]s &
 hospital p]sonnel to communicate       
effectively to fur!r ! cont9uity &      
quality ( 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+ ! ex*ange (                
non-individually id5tifiable data betwe5
 ! field ,,ems ag5cy1 a ,/ate1 & !      
,f$]al ,gov]nm5t1 includ+ ! ex*ange (   
in=mation by--  7,a7 a field ,,ems ag5cy
 to ! ,/ate ,,ems ,(fice = ! purpose (  
quality improvem5t & data collection by 
! ,/ate = submission to ,,nemsis2 or    
7,b7 ! ,/ate ,,ems ,(fice to ! ,national
 ,,ems ,database ma9ta9$ by ,assi/ant   
,secret>y = ,prep>$ness & ,response4    
#abie4 ,field ,,ems work=ce developm5t  
7a7 ,9 g5]al ,= ! purpose ( promot+     
field ,,ems z a heal? pr(ession & ensur+
 ! availability1 quality1 & capability (
 field ,,ems educators1 practition]s1   
manag]s1 & m$ical directors1 ! ,assi/ant
 ,secret>y = ,prep>$ness & ,response    
%all make grants to eligible entities = 
! developm5t1 availability1 &           
dissem9ation ( field ,,ems education    
programs & c\rses t improve ! quality & 
capability ( field ,,ems practition]s1  

educators1 manag]s1 & physician m$ical  
directors4 ,9 c>ry+ out ?is section1 !  
,assi/ant ,secret>y = ,prep>$ness &     
,response %all take into consid]ation   
recomm5dations ( ,,ficems1 ,,nemsac1 &  
relevant /akehold]s4  7b7 ,eligibility  
,9 ?is section1 ! t]m eligible entity   
means an educational organization1 an   
educational in/itution1 a pr(essional   
association1 or any o!r entity involv$ 9
 & exp]i5c$ ) ! education ( field ,,ems 
practition]s1 physician m$ical          
directors1 field ,,ems manag]s &        
adm9i/rators1 & field ,,ems educators4  
7c7 ,use ( funds ,! ,assi/ant ,secret>y 
= ,prep>$ness & ,response 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 to-- 7,a7 tra9 field 
,,ems in/ructors & promote ! adoption & 
implem5tation ( ! education /&>ds       
id5tifi$ 9 ! ,em]g5cy ,m$ical ,s]vices  
,education ,ag5da = ! ,future3 ,a       
,sy/ems ,approa*1 includ+ any revisions 

!reto or successor /&>ds2  7,b7 provide 
tra9+ = in=mation sy/em work]s1 su* z   
in=mation security1 =5sic analy/s1 data 
analy/s1 network eng9e]s1 & simil> roles
 to "w 9 support ( field ,,ems data     
sy/ems2 or  7,c7 provide tra9+ & retra9+
 programs t prep>e displac$ work]s to   
ent] a field ,,ems pr(ession1 includ+   
vet]ans & milit>y ,,ems practition]s2   
7#b7 develop & implem5t educational     
c\rses p]ta9+ to-- 7,a7 improv+ !       
provision ( quality m$ical ov]sight (   
field ,,ems2  7,b7 exp&+ ! k & skills ( 
field ,,ems practition]s1 includ+ ^?    
ne$$ to provide community p>am$ic9e &   
mobile integrat$ heal? c>e2  7,c7       
und]tak+ field ,,ems educational &      
cl9ical rese>* to develop inve/igators2 
7,d7 tactical tra9+ = field ,,ems2 or   
7,e7 develop+ & exp&+ field ,,ems       
und]graduate & graduate programs2  7#c7 
evaluate education & tra9+ c\rses &     
me?odologies to id5tify optimal         
educational modalities = field ,,ems    
practition]s2  7#d7 enhance !           

opportunity = m$ical direction tra9+ & =
 promot+ appropriate m$ical ov]sight (  
field em]g5cy m$ical c>e2 or  7#e7 c>ry 
out su* o!r activities z ! ,assi/ant    
,secret>y = ,prep>$ness & ,response     
det]m9es appropriate4  7d7 ,priority ,! 
,assi/ant ,secret>y = ,prep>$ness &     
,response1 9 consultation ) relevant    
/akehold]s1 & tak+ into consid]ation !  
recomm5dations ( ,,ficems & ,,nemsac1   
%all e/abli% a sy/em ( prioritization 9 
aw>d+ grants "u ?is section to eligible 
entities4  7e7 ,duration ( grants       
,grants "u ?is section %all be = a p]iod
 ( #a to #c ye>s4  7f7 ,application ,!  
,assi/ant ,secret>y = ,prep>$ness &     
,response may n aw>d a grant to an      
eligible entity "u ?is section unless ! 
entity submits an application to su*    
,assi/ant ,secret>y 9 su* =m1 9 su*     
mann]1 & conta9+ su* agreem5ts1         
assurances1 & in=mation z ! ,assi/ant   
,secret>y may require4 ,! ,assi/ant     
,secret>y = ,prep>$ness & ,response %all
 ensure t ! requirem5ts = submitt+ an   

application "u ?is section are n unduly 
burd5some4  #abif4 ,national em]g5cy    
m$ical s]vices /rategy  7a7 ,9 g5]al ,! 
,secret>y1 act+ ?r\gh ! ,assi/ant       
,secret>y = ,prep>$ness & ,response1    
%all develop & implem5t a cohesive      
national em]g5cy m$ical s]vices /rategy 
to /r5g!n ! developm5t ( field ,,ems & !
 full cont9uum ( em]g5cy m$ical c>e &   
sy/ems at ! ,f$]al1 ,/ate1 & local      
levels to improve pati5t outcomes &     
access to high-quality c>e 9 ! field &  
develop f9anc+ models t support !       
evolution ( value-bas$ em]g5cy m$ical   
c>e4 ,9 e/abli%+ su* a /rategy1 !       
,assi/ant ,secret>y = ,prep>$ness &     
,response %all--  7#a7 solicit & consid]
 ! #bjjg & subsequ5t recomm5dations ( ! 
,in/itute ( ,m$ic9e1 ! ,national ,,ems  
,advisory ,c\ncil1 & relevant           
/akehold]s2  7#b7 consult & collaborate 
) ! ,f$]al ,int]ag5cy ,committee on     
,,ems to ensure consi/5cy ( su* national
 em]g5cy m$ical s]vices /rategy )9 !    
l>g] ,f$]al /rategy reg>d+ national     

prep>$ness & response2  7#c7 address    
issues relat$ to em]g5cy m$ical s]vices 
sy/em developm5t1 includ+-- 7,a7 !      
regionalization ( field ,,ems1 trauma1 &
 em]g5cy m$ical s]vices1 p>ticul>ly = "t
 s5sitive conditions su* z trauma1      
,,/-,segm5t ,elevation ,myoc>dial       
,inf>ction1 /roke1 neonatal pati5ts1 &  
poison+s2  7,b7 ! availability ( field  
,,ems & trauma c>e & em]g5cy m$ical     
s]vices ?r\gh\t ! ,nation2  7,c7 !      
integration ( em]g5cy m$ical c>e f !    
p]spective ( pati5ts across ! em]g5cy   
c>e cont9uum1 & acc\ntability = sy/em   
p]=mance2 &  7,d7 f9anc+ ( field ,,ems  
ag5cies1 includ+ appropriate m$ical     
ov]sight2  7#d7 promote ! pr(essional   
developm5t ( field ,,ems practition]s to
 deliv] high-quality field ,,ems1       
includ+ ! adoption by ,/ates ( !        
education /&>ds id5tifi$ 9 ! ,national  
,,ems ,education ,/&>ds & any revisions 
!reto or successor /&>ds1 includ+ !     
/&>dization ( lic5s+ ( field ,,ems      
practition]s & /&>ds ( c>e 9 accordance 

) ! ,national ,,ems ,scope ( ,practice  
,model & bas$ on be/ practices &        
evid5ce-bas$ m$ic9e1 includ+ by--  7,a7 
id5tify+ diff]5ces 9 ! levels ( c>e1    
scope ( practice1 & lic5sure requirem5ts
 among ! ,/ates2 &  7,b7 enc\rag+ ,/ates
 to adopt national m9imum /&>ds = su*   
levels ( c>e & lic5sure requirem5ts2    
7#e7 promote a culture ( safety1 includ+
 ?r\gh-- 7,a7 ! e/abli%m5t ( field ,,ems
 pati5t & practition] safety goals & !  
specific means to improve field ,,ems   
practition] & pati5t safety to a*ieve   
su* goals2 &  7,b7 ! adoption ( uni=m   
national ambulance vehicle safety &     
manufactur+ /&>ds2  7#f7 support !      
developm5t ( value-bas$ reimbursem5t =  
new mobile res\rces & models ( deliv]y t
 support ! trans=mation ( heal? c>e1    
includ+ ! full utilization ( field ,,ems
 to deliv] em]g5cy m$ical response &    
mobile m$ical s]vices includ+--  7,a7   
community p>am$ic9e = ! provision (     
co/-effective heal? c>e assessm5t &     
prev5tion s]vices2  7,b7 mobile         

integrat$ heal? c>e und]tak5            
collaboratively by a gr\p ( provid]s 9 a
 community1 includ+ local field ,,ems   
ag5cies1 to fill gaps 9 ! local heal?   
c>e sy/em2  7,c7 integrat$ injury       
prev5tion /rategies or programs2 &  7,d7
 su* o!r issues z ! ,secret>y consid]s  
appropriate2  7#g7 incorporate into su* 
/rategy prep>$ness & response objectives
 id5tifi$ 9 ! ,national ,heal? ,security
 ,/rategy "u section #bhjb 9 ord]--     
7,a7 to ensure ! capability & capacity (
 ! full spectrum ( field ,,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#h7 promote rese>* 9 em]g5cy m$ical  
s]vices & coord9ation across ,f$]al     
ag5cies und]tak+ su* rese>*1 tak+ into  
consid]ation ! ,national ,,ems ,rese>*  
,ag5da2  7#i7 complete ! developm5t (   
su* /rategy n lat] ?an #ah mon?s aft] ! 
date ( enactm5t ( ! ,field ,,ems        
,mod]nization & ,innovation ,act2  7#aj7

 communicate su* /rategy to ! relevant  
congressional committees ( jurisdiction2
  7#aa7 implem5t su* /rategy1 to ! ext5t
 practicable1 n lat] ?an #c ye>s aft] ! 
date ( enactm5t ( ! ,field ,,ems        
,mod]nization & ,innovation ,act2 &     
7#ab7 update su* /rategy n less ?an e #c
 ye>s4  #abig4 ,(fice ( ,em]g5cy ,m$ical
 ,c>e  7a7 ,e/abli%m5t ( ,(fice         
,pursuant to p>agraph #da ( ,homel&     
,security ,presid5tial ,directive       
,,hspd-#ba1 dat$ ,octob] #ah1 #bjjg1 !  
,secret>y %all e/abli% an ,(fice (      
,em]g5cy ,m$ical ,c>e "u ! direct       
au?ority ( ! ,assi/ant ,secret>y =      
,prep>$ness & ,response1 to c>ry out all
 ( ! responsibilities describ$ 9 su*    
p>agraph ( su* directive4  7b7          
,functions ,! ,assi/ant ,secret>y =     
,prep>$ness & ,response1 act+ ?r\gh !   
,(fice ( ,em]g5cy ,m$ical ,c>e1 %all    
adm9i/] ! em]g5cy m$ical s]vices        
activities & programs "u ?is "p & !     
trauma programs "u p>ts ,a ?r\gh ,d & ,h
 & %all--  7#a7 promote & fund rese>* 9 

em]g5cy m$ic9e & trauma heal? c>e2  7#b7
 promote regional p>tn]%ips & effective 
em]g5cy m$ical sy/ems 9 ord] to enhance 
appropriate triage1 di/ribution1 & c>e (
 r\t9e community pati5ts2  7#c7 promote 
local1 regional1 & ,/ate em]g5cy m$ical 
sy/ems prep>$ness = & response to public
 heal? ev5ts2  7#d7 address ! full      
spectrum ( issues t h an impact on c>e 9
 em]g5cy dep>tm5ts1 includ+ ! entire    
cont9uum ( pati5t c>e f prehospital to  
disposition f em]g5cy or trauma c>e2 &  
7#e7 coord9ate ) exi/+ executive        
dep>tm5ts & ag5cies t p]=m functions    
relat$ to em]g5cy m$ical sy/ems 9 ord]  
to ensure unifi$ /rategy1 policy1 &     
implem5tation4  7c7 ,functions1         
,p]sonnel1 ,assets1 ,liabilities1 &     
,adm9i/rative ,actions ,all functions1  
p]sonnel1 assets1 & liabilities (1 &    
adm9i/rative actions applicable to1 !   
,em]g5cy ,c>e ,coord9ation ,c5t]1 z 9   
exi/5ce on ! day be=e ! date ( !        
enactm5t ( ! ,field ,,ems ,mod]nization 
& ,innovation ,act1 %all be transf]r$ to

 ! ,(fice ( ,em]g5cy ,m$ical ,c>e       
e/abli%$ "u subsection 7a74  4  7b7     
,inclusion ( ,field ,,ems 9 ,pati5t     
,safety ,improvem5t ,section            
#iba7h77;,a7 ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bii;b-#ba7h77;,a77 
is am5d$-- 7#a7 9 clause 7i71 by ins]t+ 
field ,,ems ag5cy 7z def9$ 9 section    
#abia71 aft] cl9ical laboratory12 &     
7#b7 9 clause 7ii71 by ins]t+ field     
,,ems 7z def9$ 9 section #abia7 m$ical  
director1 em]g5cy m$ical te*nician1 aft]
 ph>maci/14  #e4 ,integration ( field   
,,ems into ! ,national ,heal? ,in=mation
 ,infra/ructure  7a7 ,national ,,ems    
in=mation sy/em  7#a7 ,transf] (        
au?ority ,! au?ority = ! adm9i/ration ( 
! ,national ,,ems ,in=mation ,sy/em1    
includ+ ! ,national ,,ems ,database1    
%all be transf]r$ f ,,nhtsa to !        
,national ,coord9ator = ,heal?          
,in=mation ,te*nology4  7#b7 ,national  
,,ems in=mation sy/em ,section #cjja7;c7
 ( ! ,public ,heal? ,s]vice ,act 7#db   
,u4,s4,c4 #cjj;jj-#aa7;c77 is am5d$ by  

add+ at ! end ! foll[+3  7#i7 ,national 
,,ems in=mation sy/em  7,a7 ,/&>dization
 ,! ,national ,coord9ator %all promote !
 collection & report+ ( data on field   
,,ems 7z def9$ 9 section #abia7 9 a     
/&>diz$ mann]4  7,b7 ,availability (    
data ,! ,national ,coord9ator %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,c7 ,te*nical 
assi/ance ,9 c>ry+ out subp>agraph 7,a71
 ! ,national ,coord9ator may provide    
te*nical assi/ance to ,/ate & local     
ag5cies1 field ,,ems ag5cies1 & o!r     
entities1 z ! ,national ,coord9ator     
det]m9es appropriate1 to assi/ 9 !      
collection1 analysis1 & report+ ( data4 
4  7b7 ,assimilation ( pati5t heal?     
in=mation across ! em]g5cy c>e cont9uum 
,n lat] ?an #ah mon?s aft] ! date (     
enactm5t ( ?is ,act1 tak+ into acc\nt ! 
def9ition ( heal? c>e provid] "u section
 #cjjj ( ! ,public ,heal? ,s]vice ,act  

7#db ,u4,s4,c4 #cjj;jj71 ! ,secret>y    
%all promulgate a regulation t          
specifically includes em]g5cy m$ical    
s]vice provid] "u ! def9ition ( heal?   
c>e provid] = purposes ( title ,,xxx ( !
 ,public ,heal? ,s]vice ,act1 to enable 
& facilitate ! integration &            
assimilation ( field ,,ems data sy/ems z
 "p ( ! electronic ex*ange & use ( heal?
 in=mation & ! ent]prise integration (  
su* in=mation4  7c7 ,,gao evaluation    
7#a7 ,9 g5]al ,! ,comptroll] ,g5]al ( ! 
,unit$ ,/ates1 9 consultation ) !       
,national ,coord9ator = ,heal?          
,in=mation ,te*nology1 ! ,assi/ant      
,secret>y = ,prep>$ness & ,response1 & !
 ,f$]al ,int]ag5cy ,committee on        
,em]g5cy ,m$ical ,s]vices1 z            
appropriate1 & tak+ into consid]ation   
input f relevant /akehold]s1 %all       
und]take an evaluation ( issues1        
imp$im5ts1 & pot5tial solutions p]ta9+  
to integration ( field ,,ems into !     
,national ,heal? ,in=mation             
,infra/ructure4  7#b7 ,report ,!        

,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit a report to ,congress       
detail+ ! ext5t to :i* ! ,secret>y (    
,heal? & ,human ,s]vices 7ref]r$ to 9   
?is subsection z ! ,secret>y7 has       
au?ority to implem5t solutions to a*ieve
 su* integration & ! ext5t to :i*       
/atutory *anges are requir$ to a*ieve   
su* integration4  7#c7 ,cont5ts ,!      
evaluation "u p>agraph 7#a7 & report "u 
p>agraph 7#b7 %all address-- 7,a7 !     
integration ( pati5t heal? in=mation    
reg>d+ c>e provid$ to pati5ts 9 field   
,,ems into ea* pati5t's electronic heal?
 c>e record2  7,b7 ! bi-directional     
integration & data %>+ among provid]s & 
entities provid+ pati5t c>e relat$ to   
p]=mance measures z "p ( quality        
initiatives2  7,c7 ! means by :i* to    
a*ieve contemporane\s field ,,ems       
practition] access to a pati5t's m$ical 
record )\t reg>d to physical location   
:ile prep>+ to provide or provid+ c>e to
 t pati5t 9 ! field1 = ! purpose (      
enhanc+ c>e deliv]y & populat+ !        

electronic heal? c>e record 9 real "t2 &
  7,d7 incorporation ( pati5t heal?     
in=mation creat$ subsequ5t to ! receipt 
( field ,,ems c>e into ! ,national ,,ems
 ,in=mation ,sy/em1 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 ! ,national ,,ems ,in=mation  
,sy/em1 be pot5tially useful 9 evaluat+ 
& improv+ ! quality ( ,,ems c>e2  7ii7  
h[ be/ to integrate su* in=mation into !
 ,national ,,ems ,in=mation ,sy/em2     
7iii7 pot5tial modifications to ! ,heal?
 ,in=mation ,te*nology = ,economic &    
,cl9ical ,heal? ,act 7title ,,xiii (    
division ,a & title ,,iv ( division ,b (
 ,public ,law #aaa-e7 to require        
eligible hospitals 7z def9$ 9 section   
#ahhf7n77#f77;,b7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4                     
#acieww7n77#f77;,b777 to develop or     
report relevant data to ! ,national     

,,ems ,in=mation ,sy/em or o!r          
appropriate ,/ate or private regi/ries =
 ! purpose ( det]m9+ :e!r su* a hospital
 %all be--  7,i7 subject to a r$uction 9
 ! applicable p]c5tage increase o!rwise 
applicable to su* hospital "u section   
#ahhf7;b77#c77;,b77ix7 ( su* ,act2 or   
7,,ii7 eligible = an inc5tive paym5t "u 
section #ahhf7n7 ( su* ,act2  7iv7      
pot5tial modifications to ! ,m$ic>e &   
,m$icaid programs "u titles ,,xviii &   
,,xix1 respectively1 ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acie et  
seq42 #acif et seq47 or o!r ,f$]al heal?
 programs to provide appropriate        
reimbursem5t & f9ancial inc5tives =     
field ,,ems ag5cies to develop or report
 relevant data to ! ,national ,,ems     
,in=mation ,sy/em or o!r appropriate    
,/ate or private regi/ries2 &  7v7 any  
o!r *anges to improve integration (     
pati5t heal? in=mation across ! cont9uum
 ( em]g5cy m$ical c>e & bidirectional   
integration & data %>+ relat$ to        
p]=mance measures t ! ,secret>y has     

au?ority to implem5t or t requires a    
/atutory *ange by ,congress to enable ! 
,secret>y su* au?ority to implem5t4  #f4
 ,cl>ification ( lead]%ip responsibility
 = r\t9e em]g5cy m$ical c>e  7a7 ,9     
g5]al ,pursuant to ! designation ( !    
,secret>y ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is section z ! ,secret>y7 
"u section #bhja ( ! ,public ,heal?     
,s]vice ,act 7#db ,u4,s4,c4 #cjj;hh7 to 
lead all ,f$]al public heal? & m$ical   
response to public heal? em]g5cies &    
incid5ts "u ! ,national ,response ,plan 
7develop$ pursuant to section           
#ejd7;a77#f7 ( ! ,homel& ,security ,act 
( #bjjb71 & pursuant to ! ,secret>y's   
responsibility = adm9i/ration ( titles  
,,xviii1 ,,xix1 & ,,xxi ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acie et  
seq42 #acif et seq42 #acig;aa et seq471 
su* lead]%ip responsibilities %all be   
con/ru$ to include ! provision ( r\t9e  
em]g5cy m$ical c>e across ! full        
cont9uum ( su* c>e provid$ 7includ+     
field ,,ems 7z def9$ 9 section #abia ( !

 ,public ,heal? ,s]vice ,act 7z add$ by 
section #d771 trauma1 & hospital em]g5cy
 m$ical c>e7 z a necess>y pr]equisite to
 ensure ! adequacy ( su* response to    
public heal? em]g5cies & incid5ts "u !  
,national ,response ,plan & !           
integration & provision ( em]g5cy m$ical
 c>e provid$ to b5efici>ies ( su* titles
 ( ! ,social ,security ,act4  7b7       
,em]g5cy m$ical c>e sy/em ,9 accordance 
) subsection 7a71 ! ,secret>y %all be   
responsible =-- 7#a7 improv+ ! em]g5cy  
m$ical c>e sy/em provid+ r\t9e em]g5cy  
m$ical c>e to pati5ts ) em]g5cy m$ical  
conditions to enhance ! capacity ( !    
exi/+ public heal? & em]g5cy m$ical     
sy/em to prep>e = & su/a9 su* public    
heal? & m$ical response to public heal? 
em]g5cies & incid5ts2 &  7#b7 ! quality1
 innovation1 & co/-effectiv5ess ( field 
,,ems1 includ+ su* s]vices provid$ to   
individuals :o are b5efici>ies ( !      
,m$ic>e1 ,m$icaid or ,/ate ,*ildr5's    
,heal? ,insurance ,program "u titles    
,,xviii1 ,,xix1 & ,,xxi1 respectively ( 

! ,social ,security ,act 7#db ,u4,s4,c4 
#acie et seq42 #acif et seq42 #acig;aa  
et seq474  #g4 ,enhanc+ evid5ce-bas$ c>e
 9 field ,,ems  7a7 ,field ,,ems        
,em]g5cy ,m$ical ,rese>*  7#a7 ,9 g5]al 
,! ,secret>y ( ,heal? & ,human ,s]vices 
7ref]r$ to 9 ?is subsection z !         
,secret>y7 %all und]take a compreh5sive 
evaluation ( ! ext5t to :i* rese>* &    
evaluation relat+ to field ,,ems is     
conduct$ by ! ,national ,in/itutes (    
,heal?1 ! ,ag5cy = ,heal?c>e ,rese>*    
,quality1 ! ,c5t] = ,m$ic>e  ,m$icaid   
,innovation1 ! ,heal? ,res\rces &       
,s]vices ,adm9i/ration1 ! ,c5t]s =      
,disease ,control & ,prev5tion1 & !     
,pati5t-,c5t]$ ,outcomes ,rese>*        
,in/itute1 & any o!r ag5cies or         
dep>tm5ts )9 ! ,dep>tm5t ( ,heal? &     
,human ,s]vices1 z ! ,secret>y det]m9es 
appropriate4  7#b7 ,report to ,congress 
,n lat] ?an #a ye> aft] ! date (        
enactm5t ( ?is ,act1 ! ,secret>y %all   
submit to ,congress a report t          
includes--  7,a7 in=mation relat$ to !  

ext5t ( f$]ally sponsor$ rese>* 9 field 
,,ems2  7,b7 id5tification ( any        
imp$im5ts to enhanc+ rese>* 9 em]g5cy   
m$ic9e to improve pati5t outcomes2 &    
7,c7 opportunities to enhance su* rese>*
 )9 exi/+ fund+ levels4  7#c7 ,def9ition
 ,9 ?is subsection1 ! t]m field ,,ems   
has ! mean+ giv5 su* t]m 9 section #abia
 ( ! ,public ,heal? ,s]vice ,act1 z add$
 by section #d4  7b7 ,field ,,ems ,c5t] 
( ,excell5ce ,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 c5t] ( excell5ce  7a7
 ,e/abli%m5t ,! ,director %all e/abli%  
)9 ! ,(fice ( ,plann+1 ,rese>*          
,evaluation a ,field ,,ems              
,evid5ce-,bas$ ,c5t] ( ,excell5ce       
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>*1 especially ) reg>d to ! highe/  
co/ & mo/ preval5t em]g5cy m$ical       
conditions ) ! greate/ opportunity to   
improve pati5t outcomes & l[] co/s by   
c>e provid$ 9 ! field2  7#b7 o!r        
appropriate cl9ical or sy/ems rese>* on 
! effectiv5ess ( exi/+ & pot5tial       
treatm5ts provid$ 9 ! field t translate 
into improv$ quality1 outcomes1 & pati5t
 satisfaction2  7#c7 specific rese>*    
topics design$ to save lives1 l[] co/s1 
& improve outcomes = pati5ts ) em]g5cy  
m$ical conditions1 includ+--  7,a7 !    
cl9ical value & b5efit ( critical c>e   
gr\nd & air transport1 includ+ !        
pot5tial = bidirectional c>e t fills    
gaps 9 rural & o!r und]s]v$ geographic  
regions1 especially :]e hospitals h     
clos$2  7,b7 ! application ( lessons    
le>n$ 9 milit>y field m$ic9e 9 ! deliv]y
 ( em]g5cy m$ical c>e 9 field ,,ems2    
7,c7 ! ability to int]v5e cl9ically 9 ! 
e>ly onset ( an em]g5cy m$ical condition
 t w improve pati5t outcomes2  7,d7     

specific treatm5t modalities & protocols
 t are co/-effective & produce bett]    
outcomes1 su* z #ab-lead                
electroc>diograms & cont9u\s positive   
airway pressure2 &  7,e7 m$ical         
conditions mo/ conducive to             
regionalization ( em]g5cy c>e t w be mo/
 effective 9 improv+ s]vice deliv]y1    
outcomes1 & co/-effectiv5ess2 &  7#d7   
support rese>* be+ conduct$ by academic 
m$ical c5t]s1 p>ticul>ly ^? ) c5t]s (   
excell5ce =m$ ar\nd ,,ems rese>*4  7c7  
,def9ition ,9 ?is section1 ! t]m field  
,,ems has ! mean+ giv5 su* t]m 9 section
 #abia4  4  7c7 ,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 ,act1 section #ich (
 ! ,public ,heal? ,s]vice ,act1 or      
section #g7;a7 ( ! ,field ,,ems         
,mod]nization & ,innovation ,act4  7d7  
,regulatory b>ri]s ,= ! purposes (      
rese>* conduct$ pursuant to section     

#aaae;,a7b77#b77;,d77iv7 ( ! ,social    
,security ,act 7z add$ by section       
#c7;a77#b771 subsection 7a7 ( ?is       
section1 section #ich ( ! ,public ,heal?
 ,s]vice ,act 7z add$ by subsection     
7b771 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$]al /atutes necess>y to
 address su* b>ri]s4  #h4 ,em]g5cy      
m$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$ical s]vices  ,sec4 #fjig4   
,designation by individuals4  #fjig4    
,designation by individuals  7a7 ,9     
g5]al ,e individual 7o!r ?an a          
nonresid5t ali57 may designate t-- 7#a7 
a specifi$ 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 #aj ( ! 
,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]vices  4  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$ical    
,s]vices ,tru/ ,fund44  7d7 ,effective  
date ,! am5dm5ts made by ?is section    
%all apply to taxable ye>s beg9n+ aft]  
,decemb] #ca1 #bjae4  #i4 ,,gao /udy to 
id5tify imp$im5ts to quality improvem5t 
9 field ,,ems  7a7 ,9 g5]al ,!          
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all complete a /udy on imp$im5ts to !  
ability ( field ,,ems practition]s1     
physician m$ical directors1 & ag5cies to
 improve ! quality ( m$ical c>e provid$ 
to pati5ts includ+--  7#a7 m$ical &     
adm9i/rative liability issues t may     
imp$e-- 7,a7 m$ical ov]sight provid$ by 
physicians directly reg>d+ specific     
pati5ts & m$ical ov]sight provid$ by    
physicians 9 e/abli%+ m$ical protocols1 
proc$ures1 & o!r activities relat$ to ! 
provision ( em]g5cy m$ical c>e 9 field  
,,ems2 &  7,b7 ! highe/ quality em]g5cy 
m$ical c>e 9 field ,,ems provid$ by     
p]sonnel o!r ?an physicians1 su* z      

em]g5cy m$ical te*nicians & p>am$ics2   
7#b7 ! types & levels ( reimbursem5t    
necess>y to ensure ! highe/ quality (   
c>e ov]se5 by physician m$ical          
directors1 includ+--  7,a7 ! actual co/s
 ( all compon5ts ( m$ical ov]sight 9    
high-p]=m+ ,,ems sy/ems ) demon/rat$    
improvem5t 9 outcomes1 su* z ^? evid5c$ 
by c>diac rates & traumatic injury      
survival rates2  7,b7 ! co/s ( m$ical   
ov]sight = "p-"t or volunte] m$ical     
directors2  7,c7 recomm5d$ paym5t model 
options = m$ical ov]sight t w enhance   
quality ( c>e2 &  7,d7 ! suffici5cy1 or 
lack ( suffici5cy1 ( reimbursem5t "u !  
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 to provid]s & suppli]s ( 
ambulance s]vices to enable high-quality
 & appropriate m$ical ov]sight2  7#c7   
issues t may adv]sely impact ! ability (
 field ,,ems practition]s to deliv]     
high-quality c>e includ+--  7,a7 issues 
affect+ ! direct pati5t c>e provid$ by  
field ,,ems practition]s su* z p]sonal &

 pati5t safety1 fatigue1 & tra9+2 &     
7,b7 issues affect+ ! ability to recruit
 & ma9ta9 a highly qualifi$ field ,,ems 
practition] work=ce su* z sal>y1 h\rs1 &
 b5efits2 &  7#d7 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  7b7 ,report to congress ,n lat] 
?an #ah mon?s aft] ! date ( ! enactm5t (
 ?is ,act1 ! ,comptroll] ,g5]al ( !     
,unit$ ,/ates %all complete ! /udy "u   
subsection 7a7 & submit a report to     
,congress on ! results ( su* /udy1      
includ+ any recomm5dations4  7c7        
,def9itions ,9 ?is subsection1 ! t]ms   
em]g5cy m$ical c>e & field ,,ems h !    
mean+s giv5 su* t]ms 9 section #abia ( !
 ,public ,heal? ,s]vice ,act 7z add$ by 
section #d74  #aj4 ,fund+  7a7 ,9 g5]al 
,out ( am\nts 9 ! ,em]g5cy ,m$ical      
,s]vices ,tru/ ,fund1 !re are au?oriz$  
to be transf]r$ to ! ,secret>y ( ,heal? 
& ,human ,s]vices--  7#a7 #ab1jjj1jjj = 
ea* ( fiscal ye>s #bjaf ?r\gh #bjba1 = !

 purpose ( c>ry+ out ! additional duties
 requir$ "u "p ,i ( ! ,public ,heal?    
,s]vice ,act 7z add$ by section #d72    
7#b7 #bjj1jjj1jjj = ea* ( fiscal ye>s   
#bjaf ?r\gh #bjba1 = ! purpose ( c>ry+  
out section #abib ( ! ,public ,heal?    
,s]vice ,act1 z add$ by section #d2     
7#c7 #ae1jjj1jjj = ea* ( fiscal ye>s    
#bjaf ?r\gh #bjba1 = ! purpose ( c>ry+  
out section #abie ( ! ,public ,heal?    
,s]vice ,act1 z add$ by section #d2     
7#d7 #dj1jjj1jjj = ea* ( fiscal ye>s    
#bjaf ?r\gh #bjba1 = ! purpose ( c>ry+  
out section #g7;a7 ( ?is ,act & #ich ( !
 ,public ,heal? ,s]vice ,act1 z add$ by 
section #g7;b72 &  7#e7 #d1jjj1jjj = ea*
 ( fiscal ye>s #bjaf ?r\gh #bjba1 = !   
purpose ( c>ry+ out section             
#cjja7;c77#i7 ( ! ,public ,heal? ,s]vice
 ,act ) respect to ! ,national ,,ems    
,in=mation ,sy/em1 z add$ by section    
#e7;a77#b74  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 section       
#g7;a71 & 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     
#bjaf & #bjag1 up to #dj1jjj1jjj may be 
us$ = c>ry+ out ! am5dm5ts made by      
sections #c & #d4  7#b7 ,relation to o!r
 funds ,! am\nt ( discretion>y funds    
allocat$ "u p>agraph 7#a7 %all be 9     
addition to1 n 9 lieu (1 ! am\nt (      
discretion>y funds t w\ld o!rwise be    
available = su* purposes4  7d7          
,adm9i/rative exp5ses ,n m ?an #e p]c5t 
( ea* am\nt made available "u p>agraphs 
7#a7 ?r\gh 7#e7 ( subsection 7a7 may be 
us$ = adm9i/rative exp5ses4  #aa4       

,/atutory con/ruction ,no?+ 9 ?is ,act1 
includ+ ! am5dm5ts made by ?is ,act1    
%all be con/ru$ to sup]s$e any /atutory 
au?ority ( any ,f$]al ag5cy t is n )9 ! 
,dep>tm5t ( ,heal? & ,human ,s]vices4