This proposal is seriously flawed.  Putting asside the absence of a clear explanation of the of what the proposal is seeking to accomplish and the poor draftsmanship of many provisions which will raise a host of problems and issues, this proposal contains two major shifts in policy that will dramtically impact most, in not all, EMS agencies.

The first of these is contained in Section 940 which addresses impaired EMS personnel.  The section addresses 2 concepts: prohibiting personnel impaired by drug or alcohol from administering patient care or operating a motor vehicle; and requiring every EMS agency to have a substance abuse program.  Both are laudable goals

The regulatory language chosen is the problem.  What constitues impairment?  For alcohol is it the same as the standard for blood and breath levels when operating a motor vehicle or is it lower?  If it is lower, how is the threshold being set and what method is used to determine who exceeds the threshold?  What consequence flows for violating whatever the criteria is?  What is the consequence of refusing to participate in a testing regimine desinged to ferret out impairment? 

When you switch to "drugs" the issue gets even worse.  What drugs are we talking about?  Assuming that the staring point is Federally prohibited substances, that is a shifting target.  The way to define the forbiden substances in that context is to use the Federal rules by cross referencing them.  Then there are the legally available drugs.  Any number of presciption and over the counter drugs come with warnings about potential adverse side effects.  If cold remedies make a person drowsy, does that constitue "impairment" under this rule?  What about use of a muscle relaxant taken by virtue of  a doctor's prescription?   What test is going to be employed to determine whether an EMT is "impaired"?

Next look at issue of the agency policy and the same types of issues are just below the surface.  The policy must have a testing process to screen for use drugs and alcohol.  Most, if not all, substance abuse professionals will say that for a screening process to be effective it must include unannounced, random, mandatory testing under closely supervised conditions.  I seriously doubt most people are aware of the implications from this section.  Just think about the employment and liability  implications for some organizations and the complince burden for small organizations. If an EMS agency tries to avoid some of these pitfalls with a loosely worded policy they run a whole different set of risks.  For example, what consequences flow from non-compliance is hard to determine.

Section 610 is another policy shift that seems loaded with potential for posing difficulty.  It does three things:  establishes a timeframe for responding to calls, imposes a recordkeeping burden; and requires an annual review to determine if 90% of the agencies calls are responded to within the established timeframe.  Look first at the process for establishing the time frame.  Initially the OMD is excluded from the process.  Then, instead of using the County Director of Emergency Service who by law should be the Chair of the Board of Supervisors as decision maker, it tasks the local government which it defines as the whole Board of Supervisors as the decision maker.  It is hard to envision a better way to ensure making this issue a political football.  Assuming that obstacle can be overcome, no ageny can avoid the need to keep a new set of records and many agencies will get to struggle with liability issues relating to timelyness.   Ignoring those matters, look at the need to meet the standard 90% of the time.  Ther are no clear answers to what conseqences flow form the failure to accomplish that goal.  

There are any number of other problems with the draft.  Some have been mentioned by other commenters.  Try asking somebody to read this and tell you in their words what training a person needs to become a basic EMT.  The rule says the person must attend 85% of the course.  That can mean  we talking 85% of a set number of hours, or 85% of the classes or s85% of the subject matters covered.  The clarity with which the proposal defines which equipment must be present on an ALS ambulance is another delight.  I wonder if everyone knows what an EMT enhanced package is and I'd be curious to know if they recognize that it does not include an EKG monitor.

I plan to submit written comments to the Board of Health that will cover a range of other concerns.  I thought it would be helpful to share these thoughts now,