Guam § 84121 - Guam Enhanced/NextGen Emergency 911

§ 84121. Guam Enhanced/NextGen Emergency 911

Telephone Communications System.

(a) This Section shall be known and may be cited as the

“Emergency Medical Dispatch Provision.”

(b) Legislative Intent. I Liheslatura (the Legislature) finds

that there is no single governmental agency designated with the

authority to establish, administer, and maintain the existing

emergency 911 telephone communications system that is

presently stationed at Civil Defense. It is the intent of I Liheslatura

to transfer all programs, positions and personnel, property, and

appropriations which are currently under the direction of Civil

Defense to the Guam Fire Department. I Liheslatura finds that the

emergency 911 system has not been effectively and efficiently

operational due to a lack of personnel, funding, supplies and

equipment, and above all, coordinated efforts. I Liheslatura finds

that a full-time EMS Administrator, administrative support staff,

a part-time EMS Medical Director and funding for personnel,

training, and communications equipment are critically needed in

order to establish a fully fledged Emergency 911 telephone

communications system. Such a system will provide the residents

of Guam with rapid and direct access to agencies with the intent

of reducing the response time to situations requiring law

enforcement, fire, medical, rescue, and other emergency services.

I Liheslatura further finds that Public Law 21-61 appropriated a

portion of One Million Three Hundred Forty-three Thousand One

Hundred Sixty Dollars ($1,343,160) to the Department of Public

Works for the procurement of an emergency 911 communications

system for all public safety and emergency response agencies. In

1992, under former Governor Joseph Ada’s administration, a

memorandum was executed by the Governor for Civil Defense to

oversee the then newly installed emergency 911 system. This

directive was to provide administrative supervision for the

uniformed operators assigned from the Guam Police and the

Guam Fire Department. The assignment of the police and fire

personnel was supposedly a temporary agreement until training

and recruitment of permanent civilian operators was completed.

As of this date, no formal training has been made to handle the

emergency 911 calls. Police Officers and GFD firefighter

personnel continue to be temporarily assigned as emergency 911

operators on a rotational basis. I Liheslatura finds that there is a

critical need for a unified direction and administration to resolve

the current fragmented, referral type service, for training of the

emergency 911 call takers with EMT background, and a need for

funding to include training, additional personnel, and additional

emergency 911 communications equipment.

(c) Definitions:

(1) Advanced life support (ALS) provider shall mean

special services designed to provide definitive pre-hospital

emergency medical care, including, but not limited to,

cardiopulmonary resuscitation, cardiac monitoring, cardiac

defibrillation, advanced airway management, intravenous

therapy, administration of specified drugs and other

medicinal preparations, and other specified techniques and

procedures administered by authorized personnel under the

direct supervision of a base hospital as part of a local EMS

system at the scene of an emergency, during transport to an

acute care hospital, during inter-facility transfer, and while in

the emergency department of an acute care hospital until

responsibility is assumed by the emergency or other medical

staff of that hospital.

(2) Call routing shall mean the reception of emergency

calls where the purpose is to only determine the course of

direction of routing (police, fire, and medical) resulting in

rapid transfer of medical emergency callers to the Guam Fire

Department or EMD call-taker for emergency medical

dispatching services.

(3) Compliance to protocol shall mean the adherence to

the written text or scripts and other processes within the

approved emergency medical dispatch protocol reference

system except that, deviation from the text or script may only

occur for the express purpose of clarifying the meaning or

intent of a question or facilitating the clear understanding of

a required action, instruction, or response from the caller.

(4) Continuing Dispatcher Education (CDE) shall mean

medical dispatch relevant educational experiences in

accordance with standards set forth in national standards

established for the practice for emergency medical

dispatching (i.e. ASTM F 1560 Standard Practice for

Emergency Medical Dispatch, Section 13, Department of

Transportation, National Highway Traffic Safety

Administration, Association of Public Safety

Communications Officials, and/or National Emergency

Medical Dispatch).

(5) Continuous quality improvement (CQI) program

shall mean a program administered by the emergency

medical dispatch provider agency for the purpose of ensuring

safe, efficient, and effective performance of emergency

medical dispatchers in regard to their use of the emergency

medical dispatch protocol reference system, and patient care

provided. This program includes at its core the following: the

random case review process; evaluating emergency medical

dispatcher performance; providing feedback of emergency

medical dispatch protocol reference system compliance

levels to emergency medical dispatchers; and submitting

compliance data to the emergency medical dispatch medical

director.

(6) Course Curriculum Certification Agency shall mean

the Guam Office of EMS.

(7) Dispatch life support (DLS) shall mean the

knowledge, procedures, and skills used by trained

Emergency Medical Dispatchers in providing care and

advice through pre-arrival instructions and post-dispatch

instructions to callers requesting emergency medical

assistance.

(8) EMD medical direction shall mean the management

and accountability for the medical care aspects of an

emergency medical dispatch agency, including:

responsibility for the medical decision and care advice

rendered by the emergency medical dispatcher and

emergency medical dispatch agency; approval and medical

control of the operational emergency medical dispatch

priority reference system; evaluation of the medical care and

pre-arrival instructions rendered by the EMD personnel;

direct participation in the EMD system evaluation of the

medical care and pre-arrival instructions rendered by the

EMD personnel; direct participation in the EMD system

evaluation and continuous quality improvement process; and

the medical oversight of the training of the EMD personnel.

(9) Emergency Medical Dispatch Medical Director

(EMD Medical Director) shall mean a Guam licensed

physician, board certified or qualified in emergency

medicine, who possesses knowledge of emergency medical

systems in Guam approved by the Office of EMS, and who

provides Emergency Medical Dispatch Medical Direction to

the emergency medical dispatch provider agency or business,

and shall also be the EMS Medical Director.

(10) Emergency Medical Dispatcher shall mean a

person trained to provide emergency medical dispatch

services in accordance with guidelines approved by the

Guam Office of EMS, who is certified in Guam and who is

employed by an emergency medical dispatch provider

agency or business in accordance with this Act.

(11) Emergency Medical Dispatching shall mean the

reception, evaluation, processing, and provision of dispatch

life support, management of requests for emergency medical

assistance, and participation in ongoing evaluation and

improvement of the emergency medical dispatch process.

This process includes identifying the nature of the request,

prioritizing the severity of the request, dispatching the

necessary resources, providing medical aid and safety

instructions to the callers, and coordinating the responding

resources as needed, but does not include call routing per se.

(12) Emergency Medical Dispatch Provider Agency

(EMD Provider Agency) shall mean the Guam Fire

Department that accepts the responsibility to provide

emergency medical dispatch services for emergency medical

assistance, and is certified in Guam in accordance with this

Act.

(13) Emergency Medical Dispatch Priority Reference

System (EMDPRS) shall mean an Office of EMS and EMD

Medical Director approved system that includes the protocol

used by an emergency medical dispatcher in an emergency

medical dispatch agency to dispatch aid to medical

emergencies that includes: systematized caller interrogation

questions; systematized dispatch life support instructions;

systematized coding protocols that match the dispatcher’s

evaluation of the injury or illness severity with the vehicle

response mode and vehicle response configuration; a

continuous quality improvement program that measures

compliance to protocol through ongoing random case review

for each EMD; and a training curriculum and testing process

consistent with the specific EMDPRS protocol used by the

emergency medical dispatch agency.

(14) Emergency Medical Dispatch Services shall mean

the process for taking requests for emergency medical

assistance from the public, identifying the nature of the

request, prioritizing the severity of the request based on the

emergency medical dispatch provider agency’s local policies

and procedures, dispatching the necessary resources,

providing medical aid and safety instructions to the callers,

and coordinating the responding resources as needed.

(15) Enhanced Emergency-911/NextGen-911 shall

mean the telephone communications system specifically

designated for handling the emergency, medical, rescue, and

public safety telephone communications needs of Guam,

which automatically indentifies the caller’s telephone

number and location with capabilities to receive and transmit

SMS, Video Message and Access For Individuals With

Hearing And Speech Disabilities.

(16) Post-Dispatch Instructions (PDI) shall mean case-

specific advice, warnings and treatments given by trained

EMDs whenever possible and appropriate to callers after

dispatching field responders. These protocols are part of an

EMDPRS.

(17) Pre-Arrival Instructions (PAI) shall mean the

current medically approved scripted medical instructions

given in life threatening situations whenever possible and

appropriate, where correct evaluation, verification, and

advice given by emergency medical dispatchers is essential

to provide necessary assistance and control of the situation

prior to the arrival of emergency medical services personnel.

These protocols are part of an EMDPRS and are used as close

to a word-for-word as possible.

(18) Quality Assurance and Improvement Program shall

mean a program approved by the Office of EMS and

administered by the EMD Provider Agency for the purpose

of ensuring safe, efficient, and effective performance of

EMDs in regard to their use of the EMDPRS and patient care

advice provided. This program shall include at a minimum,

the random case review evaluating EMD performance,

feedback of EMDPRS compliance levels to EMDs related to

CDE retraining and remediation, and submission of

compliance data to the Medical Director and the Office of

EMS.

(19) Vehicle response configuration shall mean the

specific vehicle(s) of varied types, capabilities, and numbers

responding to render assistance.

(20) Vehicle response mode shall mean the use of

emergency driving techniques, such as warning lights-and-

siren or routine driving response as assigned by the EMS

agency and approved by the EMS Medical Director.

(d) Certification.

(1) No person may represent himself/herself as an

emergency medical dispatcher unless certified in Guam by

the Office of EMS as an emergency medical dispatcher.

(2) No business, organization, or government agency

may represent itself as an emergency medical dispatch

agency unless the business, organization, or government

agency is certified by the Office of EMS as an emergency

medical dispatch agency.

(e) National Standards Required.

The Office of EMS shall use applicable national standards

when developing the rules and regulations for emergency medical

dispatchers and emergency medical dispatch agencies.

(f) Authority and Responsibilities.

The Office of EMS shall have the authority and

responsibility to establish rules and regulations for the following

pursuant to this Act:

(1) Emergency Medical Dispatch Protocol Reference

System (EMDPRS).

(A) An EMD Program shall include an EMDPRS

selected by the EMD Provider Agency and approved by

the EMD Medical Director as its foundation.

(B) The EMDPRS is a medically approved

protocol based system used by emergency medical

dispatchers to interrogate callers, dispatch aid, and

provide dispatch life support instructions during

medical emergencies.

(C) An approved EMDPRS shall include:

(i) systematized caller interrogation questions;

(ii) systematized dispatch life support

instructions; and

(iii) systematized coding protocols that allow

the agency to match the dispatcher’s evaluation of

the injury or illness severity with the vehicle

response mode (emergency and/or non-

emergency) and level of care (ALS/BLS).

(2) EMD Protocols, Reporting, Training and

Curriculum:

(A) requires certification and recertification of a

person who meets the training and other requirements as

an emergency medical dispatcher;

(B) requires certification and recertification of a

business, organization, or government agency that

operates an emergency medical dispatch agency that

meets the minimum standards prescribed by the Office

of EMS for an emergency medical dispatch agency;

(C) establishes a bi-annual recertification

requirement that requires at least twelve (12) hours

medical dispatch specific continuing education each

year;

(D) requires minimum education and continuing

education for the Emergency Medical Dispatcher which

meets national standards;

(E) requires the EMD to provide dispatch life

support (including pre-arrival instructions) in

compliance with the written text or scripts, and other

processes within the approved EMDPRS;

(F) requires the EMD provider agency to have in

place Office of EMS approved policies and procedures

for the safe and effective use of the EMDPRS;

(G) requires the EMD to keep the Office of EMS

currently informed as to the entity or agency that

employs or supervises his/her activities as an

Emergency Medical Dispatcher;

(H) approves all EMDPRS protocols used by EMD

provider agencies to assure compliance with national

standards;

(I) requires that Office of EMS approved

emergency medical dispatch certification training

programs shall be conducted in accordance with

national standards, and shall include a written

examination approved by the Office of the EMS that

tests for competency in the specific of EMDPRS taught

in the approved certification training program;

(J) requires that Office of EMS approved

emergency medical dispatcher certification training

programs shall be conducted by instructors that meet the

Office of EMS approved qualifications;

(K) requires that the emergency medical dispatch

agency be operated in a safe, efficient, and effective

manner in accordance with national approved standards

including, but not limited to:

(i) All personnel providing emergency

medical dispatch services must be certified by the

Office of EMS prior to functioning alone in an

online capacity.

(ii) The use on every request for medical

assistance of an Office of EMS approved

emergency medical dispatch priority reference

system (EMDPRS).

(iii) The EMD interrogating the caller and

coding the incident must be the same EMD that

gives the DLS instructions. The EMD dispatching

the response may be another person.

(iv) Under the approval and supervision of the

Office of EMS, the establishment of a continuous

quality assurance, improvement and management

program that measures various areas of compliance

to the EMDPRS through ongoing random case

review for each EMD, and provides feedback to the

individuals and management of the EMS agency

regarding the level of compliance and

performance.

(v) A case review process evaluating the

EMD’s compliance to various Office of EMS

defined areas within the EMDPRS.

(vi) Reporting of EMDPRS performance and

compliance data at Office of EMS approved

intervals.

(vii) Office of EMS will review and approve

the EMDPRS, the EMD training program, quality

assurance/improvement program, medical dispatch

oversight committee(s), continuing dispatch

education program, and the medical aspects of the

operation of the EMD provider agency.

(viii) The EMD provider agency shall have

and use the most current version of the Office of

EMS approved EMDPRS selected for use by the

agency as defined by the Office of EMS.

(ix) The EMDPRS selected for use by the

EMD provider agency and approved by the Office

of EMS, including its questions, instructions and

protocols, shall be used as a whole and not

piecemeal;

(L) requires that a person, organization, business or

government agency may not offer or conduct a training

course that is represented as a course for an emergency

medical dispatcher certification, unless the person,

organization, or agency is approved by the Office of

EMS to offer or conduct that course;

(M) establishes recognition and reciprocity

between the Office of EMS and national standard-

setting organizations having programs that meet the

requirements contained in this Act, and the rules

established for it by the Office of EMS; and

(N) requires each EMD, EMD provider agency, or

recognized national standard-setting organization to

report to the Office of EMS whenever an action has

taken place that may require the revocation or

suspension of a certificate issued by the Office of EMS.

(3) Continuing Dispatch Education (CDE) Standards.

(A) An emergency medical dispatcher shall receive

a minimum of twenty-four (24) hours of continuing

dispatch education every two (2) years.

(B) All CDE will be submitted to the Office of

EMS for approval, and then coordinated and organized

by the EMD provider agency.

(C) CDE shall include issues identified by the

EMD continuous quality improvement process, and one

or more of the following:

(i) medical conditions, incident types, and

criteria necessary when performing caller

assessment and prioritization of medical calls;

(ii) use of the EMD protocol reference system;

(iii) call taking interrogation skills;

(iv) skills in providing telephone pre-arrival

instructions;

(v) technical aspects of the system (phone

patching, emergency procedures, etc.);

(vi) skill practice and critique of skill

performance; and/or

(vii) attendance at EMD workshops/

conferences.

(D) Methodologies for presenting CDE includes:

(i) formalized classroom lecture;

(ii) video, CD, internet;

(iii) articles;

(iv) tape reviews;

(v) participation on medical dispatch

committee; and/or

(vi) field observations (e.g. ride-along with

EMS personnel, or emergency department

observation of communications activities).

(E) Formalized classroom CDE courses must be

approved by the Office of EMS to count towards

continuing dispatch education credits.

(i) The training program provider must submit

CDE curriculum to the Office of EMS:

(aa) It is the training program provider’s

responsibility to submit the CDE curriculum

as required by the Office of EMS, and to

comply with the requisite policies and

procedures.

(bb) The training program provider shall

issue a course completion record to each

person who has successfully completed a

CDE course, and provide a list to the Office of

EMS.

(4) Continuous Quality Improvement (CQI) Standards.

(A) The EMD provider agency shall establish a

continuous quality improvement program.

(B) A continuous quality improvement program

shall address structural, resource, and/or protocol

deficiencies, as well as measure compliance to

minimum protocol compliance standards as established

by the Office of EMS through ongoing random case

review for each emergency medical dispatcher.

(C) The CQI process shall:

(i) monitor the quality of medical instruction

given to callers, including ongoing random case

review for each emergency medical dispatcher and

observing telephone care rendered by emergency

medical dispatchers for compliance with defined

standards;

(ii) conduct random or incident specific case

reviews to identify calls/practices that demonstrate

excellence in dispatch performance and/or identify

practices that do not conform to defined policy or

procedures so that appropriate training can be

initiated;

(iii) review EMD reports, and /or other

records of patient care to compare performance

against medical standards of practice;

(iv) recommend training, policies and

procedures for quality improvement;

(v) perform strategic planning and the

development of broader policy and position

statements; and

(vi) identify CDE needs.

(D) EMD case review is the basis for all aspects of

continuous quality improvement in order to maintain a

high level of service, and to provide a means for

continuously checking the system. Consistency and

accuracy are essential elements of the EMD case review.

(i) Critical components of the EMD case

review process:

(aa) Each CQI program shall have a case

reviewer(s) who is:

(1) a currently licensed or certified

physician, registered nurse, physician

assistant, EMT-P, EMT-B, or EMT-I,

who has at least two (2) years of practical

experience within the last five (5) years

in pre-hospital emergency medical

services with a basic knowledge of

emergency medical dispatch, and who

has received specialized training in the

case review process; or

(2) an emergency medical

dispatcher with at least two (2) years of

practical experience within the last five

(5) years, and who has received

specialized training in the case review

process.

(3) The case reviewer shall measure

individual emergency medical dispatcher

performance in an objective, consistent

manner, adhering to a standardized

scoring procedure.

(4) The regular and timely review of

a pre-determined number of EMD calls

shall be utilized to ensure that the

emergency medical dispatcher is

following protocols when providing

medical instructions.

(5) Routine and timely feedback

shall be provided to the EMD to allow for

improvement in their performance.

(6) The case reviewer shall provide

a compliance-to-protocol report at least

annually to the Office of EMS to ensure

that the EMD provider agency is

complying with their chosen EMDPRS

minimum protocol compliance

standards, and Agency policies and

procedures.

(5) Policies and Procedures.

(A) The EMD provider agency shall establish

policies and procedures through its continuous quality

improvement program, consistent with the emergency

medical dispatcher scope of practice that includes, but is

not limited to:

(i) ensuring the EMD call answering point

maintains direct access to the calling party;

(ii) providing systematized caller interview

questions;

(iii) providing systematized post-dispatch and

pre-arrival instructions;

(iv) establishing protocols that determine

vehicle response mode and configuration based on

the emergency medical dispatcher’s evaluation of

injury or illness severity;

(v) establishing a call classification coding

system for quality assurance and statistical

analysis;

(vi) establishing a written description of the

communications system configuration for the

service area, including telephone and radio service

resources; and

(vii) establishing a record-keeping system,

including report forms or a computer data

management system to permit evaluation of patient

care records to ensure emergency medical

dispatcher compliance with the EMDPRS, and

timeliness of interview questions and dispatch.

(6) Records Management.

(A) Course Completion Records.

(i) The EMD provider agency shall maintain a

copy of the basic EMD training program course

completion record in the individual emergency

medical dispatcher’s training file.

(ii) The EMD provider agency shall maintain

a record of “in-house” EMD CDE topics,

methodologies, date, time, location, and the

number of CDE hours completed for each session

of CDE in the individual emergency medical

dispatcher’s training file.

(iii) The EMD provider shall maintain a copy

of EMD CDE program course completion records

from an approved EMD training program provider

in the individual emergency medical dispatcher’s

training file.

(B) Training Program Provider Records.

(i) Each training program provider shall retain

the following training records as provided by the

Office of EMS:

(aa) Records on each course including,

but not limited to: course title, course

objectives, course outlines, qualification of

instructors, dates of instruction, location,

participant sign-in rosters, sample course tests

or other methods of evaluation, and records of

course completions issued.

(bb) Summaries of test results, course

evaluations or other methods of evaluation.

The type of evaluation used may vary

according to the instructor, content of

program, number of participants and method

of presentation.

(cc) CQI Case Review Records:

(1) Each EMD provider agency

shall retain compliance-to-protocol

reports as required by law.

(7) Access For Individuals With Hearing And Speech

Disabilities Will be Implemented in Current and All Future

Upgrades.

(A) The Guam Fire Department’s Emergency 911

Telephone Communications System shall be accessible

to individuals with hearing and speech disabilities.

(B) The means for such accessibility shall

primarily be mobile and landline telephones, but

nothing herein shall be construed as to limit the Guam

Fire Department from providing access to the

Emergency 911 telephone communications system

through other modes of communication.

(C) The Guam Fire Department is prohibited from

charging additional fees to telecommunications

companies and/or their customers for the cost of

providing such accessibility. Any costs associated with

the implementation of the mandates of this Subsection

shall be funded through existing surcharges.

(8) Effective Date.

The provisions of this Section shall become effective

immediately.

(9) Penalties.

(A) Any person guilty of willfully violating or

failing to comply with any provisions of this Act or

regulations set forth by the Office of EMS under

Subsection D of this Section shall be fined not more

than Two Hundred Fifty Dollars ($250), or imprisoned

not more than three (3) months, or be both fined and

imprisoned.

(B) Any agency or organization guilty of willfully

violating or failing to comply with any provision of this

Act or regulations set forth by the Office of EMS under

Subsection D of this Section shall be fined not more

than One Thousand Dollars ($1,000) or imprisoned not

more than six (6) months, or be both fined and

imprisoned.