(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

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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

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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

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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

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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

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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.

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(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;

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(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:

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(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

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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:

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(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

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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;

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(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

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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;

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(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,

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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.

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(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.

SOURCE: Added by P.L. 23-077:10 (Mar. 6, 1996). Amended by P.L.
31-146:2 (Nov. 17, 2011).

2019 NOTE: Designations in subsection (f) added/altered pursuant to the authority granted by 1 Guam Code Ann. § 1606.