Major Topic #8: Policy Development

Policy development and planning includes strategies to:

• inform, educate, and empower people about IFT issues;
  
  
• mobilize State and community partnerships to identify and solve IFT problems; and
  
  
• develop policies and plans that support State and community IFT efforts.

In many communities there is no entity with authority or responsibility for management of IFT issues. In some States/communities, formal agreement among the stakeholders may be sufficient to implement IFT strategies. Frequently, however, legislation and regulation are necessary. Whether derived from government authority or established through formal stakeholder agreement, it is important the IFT policies, procedures, authorities and responsibilities be articulated carefully and communicated to all stakeholders.

Legislation, adopted by a governing body (e.g. State legislature, county council), usually establishes which government entity is responsible for management of IFT, delineates that agency’s authority and responsibility and establishes other IFT parameters potentially including the need for a license. Frequently, the government agency, such as a state or county health department or State EMS Agency, is authorized to promulgate rules/regulations that may establish IFT licensure requirements including, for instance, personnel education and certification, safety, reporting procedures, medical direction and license suspension or revocation. Sometimes, these detailed requirements are determined by the governing body and are included in the legislation. In some States, IFT regulation authority may be contained in the State EMS agency’s authorizing legislation.

A systematic process is recommended to assess the current status of and potential need for IFT legislation and regulation including finding the answers to the following questions:

• What local, State or Federal laws and regulations directly impact IFTs in your community?
  
  
• What agency has the authority and responsibility for implementing and enforcing these laws and regulations? 
  
  
• What processes does the agency use to develop and to enforce regulations? How can you impact regulation development or modification?
  
  
• Do jurisdictions’ regulations compliment each other or do they conflict?
  
  
• What gaps or issues can you identify in the legislation or regulations?
  
  
• Is there model legislation that may be helpful in this analysis?
  
  
• Do other jurisdictions have comparable legislation that could provide comparison?

In evaluating the adequacy of existing agreements, laws, regulations or policies, the following considerations may be important:

• definition of levels of patient acuity to assist in determining appropriate personnel to use during the IFT;
• standards of care;
• minimum requirements for education and training of IFT personnel;
• inter-jurisdictional transfer issues;
• requirement for data collection or utilization of data for performance improvement;
• authority to enforce regulations.

Persons interested in developing legislation or regulations for IFT should become familiar with their jurisdiction’s system. For instance, visiting with and involving State EMS Agency staff may be essential to improving IFT policy development and implementation. The State EMS Agency can usually provide good information on the status of IFT legislation, regulation and legal decisions. Understanding of the State’s regulatory process and gaining support for authorizing legislation or regulations can reduce misunderstandings and conflict. For instance, many State EMS offices have an advisory council that provides advice on regulatory and EMS system issues. It may be important to have an individual experienced and interested in IFT issues attend the meetings and provide information on IFT issues. An ad hoc group can be formed to make recommendations for advisory council consideration.

Educating and involving third party payers may also be a key activity to improving your IFT system.

To obtain more information on statutes and administrative rules and how they affect EMS in your State, contact the State EMS office. A listing can be found at www.nasemsd.org, the Web site for the National Association for State EMS Officials.