One challenge to development of CHEMS in Montana is assurance that there are appropriate statutory authorizations. CHEMS is the delivery of primary, non-emergency care to patients (versus 9-1-1 emergency care). While most people recognize the formal development of CHEMS needs to occur, most also recognize that much of the care provided now by EMS services is already for non-emergency conditions.
CHEMS is the delivery of primary care in an attempt to decrease unnecessary use of EMS for delivery of these patients to emergency rooms. At one point, a state attorney opined that due to the references to 'emergency care' in state statutes, CHEMS is not statutorily authorized. Additional discussions and opinions about whether any non-emergency care and transfers were legal under Montana law prompted the Montana EMS Association to request an Attorney General's opinion on the matter. While attorneys are currently taking a more reasoned approach to this issue, Montana clearly needs to update statutes that are over 30 years old.
Senate Bill 104 is proposed as a fix to the legal questions whether statute allows CHEMS-CP or not. The bill appears large as it is also cleaning up language referring to 'emergency medical technicians' in many statutes. Now that the general term for the different levels of EMT and paramedics is Emergency Care Provider, that term is replacing EMT in numerous statutes.
The guts of the bill starts on pp 14-15 where it cleans up DPHHS's authorization law to clarify that its role is to develop an emergency care system (including CHEMS and future innovations).
Page 16 fixes the section of law related to EMTs. In addition to the traditional role ensuring ECPs provide care "during the first critical minutes immediately after an accident or the onset of an emergent condition, the board can work with "community-based health care integrated into the overall health care system".
Pages 18-19 edits law related to EMS services defining that they provide "prehospital or interfacility emergency medical transportation or treatment services" or "community-based health care services as part of an emergency care system that is integrated into the overall health care system".