,,ii  #aadth ,,congress  #b;d ,session  
,s4 #bicb  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #af1 #bjaf
 ,mr4 ,cassidy introduced the following 
bill2 which was read twice and referred 
to the ,committee on ,health1           
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to amend the ,controlled       
,substances ,act with respect to the    
provision of emergency medical services4
  #a4 ,short title ,this ,act may be    
cited as the ,protecting ,patient       
,access to ,emergency ,medications ,act 
of #bjaf4  #b4 ,findings ,the ,congress 
finds that--  7#a7 the use of controlled
 substances by emergency medical        
services agencies to administer medical 
care and medicines to individuals in the
 field is essential to save lives1      
manage pain1 and improve health         
outcomes2  7#b7 the unique nature of    
mobile emergency medical services is    
unlike other healthcare services        
governed by the ,controlled ,substances 
,act 7#ba ,u4,s4,c4 #hja et seq47 in    

that it requires the provision of       
time-sensitive and mobile medical care  
to individuals with critical injuries   
and illnesses in the field and movement 
of such individuals to definitive care2 
7#c7 there have been few investigations 
by the ,drug ,enforcement               
,administration related to diversion in 
emergency medical services2  7#d7 one   
recent survey of large emergency medical
 services agencies in the ,united       
,states showed less than #bj diversions 
or investigations for nearly #gj1jjj    
doses of controlled substances          
administered2  7#e7 regulatory oversight
 to prevent diversion is essential in   
all health care settings1 including     
emergency medical services2  7#f7 such  
oversight shall be carefully tailored to
 recognize unique care delivery models1 
including the provision of medical care 
to individuals by emergency medical     
services practitioners under the        
supervision of a physician medical      
director2 and  7#g7 such oversight      

should further promote uniformity of    
rules1 application and enforcement to   
prevent diversion and establish clear   
guidelines within emergency medical     
services while also recognizing the     
variety of emergency medical services   
agencies including governmental1        
nongovernmental1 private1 and volunteer 
emergency medical services agencies4    
#c4 ,emergency medical services ,part ,c
 of the ,controlled ,substances ,act    
7#ba ,u4,s4,c4 #hba et seq47 is amended 
by adding at the end the following3     
#cab4 ,emergency medical services  7a7  
,definitions ,in this section-- 7#a7 the
 term emergency medical services means  
emergency medical response1 and         
emergency mobile medical services1      
provided outside of a medical facility2 
7#b7 the term emergency medical services
 agency means an organization providing 
emergency medical services1 including an
 organization that-- 7,a7 is            
governmental 7including a fire-based    
agency71 nongovernmental 7including a   

hospital-based agency71 private1 or     
volunteer-based2 and  7,b7 provides     
emergency medical services by ground1   
air1 or otherwise2  7#c7 the term       
emergency medical services practitioner 
means a health care practitioner        
7including a nurse1 a paramedic1 or an  
emergency medical technician7 licensed  
or certified by a ,state and            
credentialed by a medical director of   
the respective emergency medical        
services agency to provide emergency    
medical services to individuals within  
the scope of the ,state license or      
certification of the practitioner2  7#d7
 the term medical director means a      
physician providing medical oversight   
for an emergency medical services       
agency2  7#e7 the term medical oversight
 means supervision of medical operations
 of an emergency medical services       
agency2  7#f7 the term standing order   
means a written medical protocol in     
which a medical director prescribes in  
advance the medical criteria to be      

followed by emergency medical services  
practitioners in administering a        
controlled substance to an individual in
 need of emergency medical services2    
7#g7 the term verbal order means a      
verbal prescription to be followed by an
 emergency medical services practitioner
 in administering a controlled substance
 to an individual in need of emergency  
medical services2  7#h7 the term online 
medical direction means verbal          
instructions provided by a physician to 
an emergency medical services           
practitioner with regard to patient care
 and treatment1 including by radio or   
telephone2 and  7#i7 the term registrant
 emergency medical services agency means
 an emergency medical services agency   
that registers under subsection 7b7 or a
 hospital that-- 7,a7 owns and operates 
an emergency medical services agency2   
and  7,b7 is registered under its own   
hospital license4  7b7 ,registration    
7#a7 ,in general ,for the purpose of    
enabling emergency medical services     

practitioners to dispense controlled    
substances in schedule ,,ii1 ,,iii1     
,,iv1 or ,v to ultimate users receiving 
emergency medical services1 the         
,attorney ,general shall1 at the request
 of the emergency medical services      
agency employing such practitioners1    
register such emergency medical services
 agency under section #cjc7;f7 in lieu  
of registering the individual           
practitioners or #a or more medical     
directors of such agency4  7#b7 ,single 
registration ,in registering an         
emergency medical services agency       
pursuant to paragraph 7#a71 the         
,attorney ,general shall require a      
single registration per ,state1 not a   
separate registration for each location 
of the emergency medical services       
agency4  7#c7 ,guidance to registrants  
,for purposes of providing guidance to  
registrant emergency medical services   
agencies1 the ,attorney ,general shall  
tailor such guidance to recognize--     
7,a7 the existing delivery of medical   

care and medical oversight to patients  
with emergency medical conditions2 and  
7,b7 the variety of emergency medical   
service care delivery models provided by
 emergency medical services agencies4   
7c7 ,medical oversight  7#a7 ,in general
 ,notwithstanding section #cji-- 7,a7 a 
registrant emergency medical services   
agency shall have #a or more medical    
directors responsible for medical       
oversight of the provision of emergency 
medical services by the agency2  7,b7   
the medical director shall be a         
physician licensed by the ,state in     
which the physician practices medicine  
and in which the emergency medical      
services agency is located2  7,c7       
subject to the authority provided by the
 ,state or a political subdivision or   
other delegated authority of such       
,state1 the responsibilities of the     
medical director may include--  7i7     
decisions with regard to transportation 
destination of patients2  7ii7 approving
 all medical protocols1 including       

standing orders2  7iii7 overseeing      
patient care delivered by emergency     
medical services practitioners of the   
emergency medical services agency1      
including--  7,i7 the evaluation1       
treatment1 and interventions of         
patients2  7,,ii7 online medical        
direction2 and  7,,iii7 establishing    
drug formularies and the dispensing and 
administering of all medications and    
controlled substances to patients2  7iv7
 overseeing medical education and       
training programs for emergency medical 
services practitioners2 and  7v7        
overseeing quality improvement for the  
emergency medical services agency2 and  
7,d7 subject to the authority provided  
by the ,state or a political subdivision
 or other delegated authority of such   
,state1 controlled substances in        
schedule ,,ii1 ,,iii1 ,,iv1 or ,v may be
 administered by the emergency medical  
services practitioners of a registrant  
emergency medical services agency in the
 course of providing emergency medical  

services pursuant to--  7i7 a standing  
order issued by #a or more medical      
directors of such agency2 or  7ii7 an   
online medical direction that includes a
 verbal order issued by #a or more      
medical directors1 or other licensed    
physician1 in accordance with a policy  
of such agency under the following      
circumstances--  7,i7 the emergency     
medical services practitioners request  
such an order with regard to a specific 
patient and the medical director        
verbally provides such an order2  7,,ii7
 the medical director provides verbal   
orders upon dispatching emergency       
medical services practitioners          
responding to an unanticipated mass     
casualty incident2 or  7,,iii7 other    
specific patient situations in which the
 medical director identifies a need to  
provide such an order to ensure proper  
care and treatment to patients4  7#b7   
,impermissible limitations on allowable 
prescriptions ,in the case of           
administering a controlled substance    

under paragraph 7#a71 the medical       
directors of the registrant emergency   
medical services agency shall not be    
required--  7,a7 to be present2 or  7,b7
 to provide a written or oral           
prescription with regard to a known     
individual before or at the time of such
 administering4  7#c7 ,documentation    
7,a7 ,in general ,a registrant emergency
 medical services agency shall keep any 
such standing order on file and make    
such standing order available to the    
,attorney ,general upon the request of  
the ,attorney ,general4  7,b7 ,policy ,a
 registrant emergency medical services  
agency shall have a policy requiring    
practitioners to document in the patient
 care chart a verbal order was received 
from online medical direction and a     
controlled substance was administered4  
,any such administration of a controlled
 substance shall be documented in the   
patient care chart as soon as           
practicable and available to the        
,attorney ,general upon the request of  

the ,attorney ,general4  7d7 ,receipt1  
movement1 and storage of controlled     
substances  7#a7 ,receipt ,the          
registrant emergency medical services   
agency-- 7,a7 may receive controlled    
substances at any location of the agency
 designated by the agency for such      
receipt2 and  7,b7 may not receive      
controlled substances at any location   
not so designated4  7#b7 ,movement and  
delivery ,the registrant emergency      
medical services agency may move or     
deliver controlled substances within the
 possession of such agency between any  
locations of such agency4 ,a registrant 
emergency medical services agency shall 
not be treated as a distributor of      
controlled substances under this ,act by
 reason of such movement or             
distribution4  7#c7 ,storage ,such      
agency-- 7,a7 may store controlled      
substances at any location of the agency
 designated by the agency for such      
storage2 and  7,b7 may not store        
controlled substances at any location   

not so designated4  7e7 ,rule of        
construction ,nothing in this section   
shall be construed to--  7#a7 alter any 
requirements under titles ,,xviii or    
,,xix of the ,social ,security ,act2 or 
7#b7 limit the authority vested in the  
,attorney ,general to enforce diversion 
of controlled substances otherwise      
provided in this ,act4  4