For the purposes of this chapter, the following terms shall have the meanings respectively ascribed to them by this section:

(1) GROUND AMBULANCE. A motor vehicle including a convalescent ambulance that is intended to be used for and is maintained or operated for transportation to a medical care facility of persons who are sick or injured.

(2) AMBULANCE SERVICE OPERATOR. Any person, firm or corporation engaged in the business of operating a ground ambulance or convalescent ambulance.

(3) LICENSED AMBULANCE DRIVER. Any individual who successfully completes the course of instruction for emergency vehicle operation prescribed by the Board of Health, and who has been granted a current, valid license by the Board of Health.

(4) LICENSED EMERGENCY MEDICAL TECHNICIAN-BASIC. Any person 18 years of age or older who has successfully completed the basic emergency medical technician course of instruction, or its equivalent, as approved by the Board of Health, and passed the state EMT-basic examination, and who has been granted a current, valid license by the Board of Health.

(5) LICENSED EMERGENCY MEDICAL TECHNICIAN-INTERMEDIATE. Any person 18 years of age or older who has successfully completed the intermediate emergency medical technician course of instruction, or its equivalent, as approved by the Board of Health, and passed the state EMT-intermediate examination, as well as having met the requirements for becoming a licensed emergency medical technician-basic, and who has been granted a current, valid license by the Board of Health.

(6) LICENSED EMERGENCY MEDICAL TECHNICIAN-PARAMEDIC. Any person 18 years of age or older who has successfully completed the EMT-paramedic course of instruction, or its equivalent, as approved by the Board of Health, and passed the state EMT-paramedic examination, as well as having met the requirements for becoming a licensed emergency medical technician-intermediate, and who has been granted a current, valid license by the Board of Health.

(7) ADVANCED LIFE SUPPORT. The treatment of potentially life-threatening medical emergencies through the use of invasive medical techniques specified as advanced life support techniques by the Board of Health, which ordinarily would be performed or provided by licensed physicians, but which may be performed by emergency medical technicians during emergencies under constraints specified by rule of the board.Board or Board of Health. The State Board of Health.

(9) PATIENT. An individual who receives or requests medical care, or for whom medical care is requested, because the individual is sick or injured.

(10) PHYSICIAN. An individual licensed to practice medicine by the Medical Licensure Commission of Alabama.

(11) CONVALESCENT AMBULANCE. A vehicle that is intended to be used for and is maintained or operated for making non-emergency calls for patients in a recumbent position who require transportation to or from a physician's office, hospital, other health care facility, or residence, provided a convalescent ambulance shall not include a hospital operated vehicle used exclusively for intra hospital facility transfers.

The provisions of this chapter shall not apply to volunteer rescue squads that are members of the Alabama Association of Rescue Squads, Inc. and which furnish ambulance service to the public; nor shall the provisions of this chapter apply to businesses or companies which provide free ambulance service to their employees; nor shall the provisions of this chapter apply to or govern ambulances owned by the county, a municipality or any other political subdivision of the state, nor to the drivers of or attendants on such ambulances in Marengo County. The governing body of such county is hereby authorized to prescribe rules and regulations governing ambulance drivers and ambulance attendants, including rules and regulations for their training and qualifications.

There is hereby created the Alabama Emergency Medical Services Education Commission. Membership on the Alabama Emergency Medical Services Education Commission shall be as follows:

(1) The State Health Officer, or his or her designee, who shall serve as chair.

(2) The State Superintendent of Education, or his or her designee.

(3) Three members appointed by the Governor.

(4) Two members appointed by the Lieutenant Governor or the President of the Senate.

(5) Two members appointed by the Speaker of the House of Representatives.

Members of the commission shall not receive compensation for their services, but shall be allowed travel and per diem expenses at the same rate paid to state employees, to be paid from funds of the Alabama Department of Public Health.

The commission shall meet at the times and places as it shall establish, or at the call of the chair after not less than five working days notice to all members. In no event shall the commission meet less frequently than twice each fiscal year.

(a) The commission shall expend the funds that are appropriated for such purpose by the Legislature by making grants to State Junior Colleges, State Technical Colleges, and other public institutions of higher learning for the purposes of providing emergency medical services education.

(b) To be eligible for a grant from the commission, an institution shall be certified by the Alabama Department of Public Health as having an emergency medical services primary education program whose graduates are eligible to be examined for state licensure as emergency medical technicians at the EMT-Basic, EMT-Intermediate, or EMT-Paramedic level or a combination thereof.

(c) Grants from the commission shall contain such conditions that in the view of the commission are necessary to assure that grant funds are expended for emergency medical services education purposes. The commission may require audited financial statements as a condition of grant acceptance.

(a) In the manner provided in this section, the State Board of Health, with advice and recommendation of the advisory board, shall establish and publish reasonable rules and regulations for the training, qualification, scope of privilege, and licensing of ambulance drivers, emergency medical technicians, and ambulance service operators and for the operation, design, equipment and licensing of ambulances and convalescent ambulances. In adopting rules and regulations, the Board of Health shall follow the provisions of the Alabama Administrative Procedure Act, provided, that the board shall, in all cases, hold one or more public hearings prior to adoption, amendment, or rescission of any rule or regulation. All hearings shall be joint hearings set by the Board of Health and the advisory board established in Section 22-18-5. At such hearing, any interested person, firm or corporation or any member of the public may be heard. Any person, firm or corporation affected by any regulation, amendment or rescission hereof may appeal consideration thereof to the circuit court of Montgomery County pursuant to the provisions of the Administrative Procedure Act.

(b) Regulations adopted under this section shall become effective as provided in the Administrative Procedure Act. From any judgment of the circuit court in any case appealed to it, an appeal shall be made pursuant to the Administrative Procedure Act.

(a) In addition to all other licenses or fees now payable, the Board of Health shall, as prerequisite for issuing a license under the provisions of this chapter and rules and regulations promulgated pursuant thereto, charge a fee of $10.00 for each license valid for a period of 24 months issued to an ambulance driver, emergency medical technician (EMT)-basic, EMT intermediate or EMT paramedic, a fee of $25.00 for each license issued to a ground ambulance service operator, and a fee of $25.00 for each license issued to a convalescent service ambulance operator. Licenses in effect on June 29, 1995, shall remain in effect until the expiration date set forth thereon. Each license issued to an ambulance service operator shall be valid for a period not to exceed 12 calendar months. The same fee shall be charged for renewal of a license as is fixed in this subsection for the original license. No additional fee shall be collected when an EMT becomes eligible for reclassification of his or her license to a higher level. All fees collected under this chapter shall be retained in a separate fund by the Board of Health for the purpose of enforcing this chapter and shall be disbursed as other funds of the state are disbursed; provided, that no fee or permit charge authorized under this chapter shall be charged or collected for the issuing of a permit to a volunteer rescue squad, as defined in Section 32-11-1, for providing ambulance service on a gratuitous basis, or any member who volunteers his service, unless licensure is requested by the squad, company or individual, whereupon, with the exception of the issuance of a license for the EMT reclassifications, a fee will be charged. An EMT may hold a dual license as an ambulance driver and an EMT at any level for which he or she is eligible for licensure, and there shall be no license fee imposed other than that imposed for an EMT license.

(b) Any person desiring licensure as an EMT shall complete an approved EMT course, successfully pass the appropriate level licensure examination as determined by the Board of Health, and submit an application to the board. An approved EMT course for any level shall be a course conforming to the curriculum for that level approved by the United States Department of Transportation, or approved by any other federal agency as may, in the future, take jurisdiction over EMT training curriculum development. A curriculum may be required to be supplemented with additional modules if:

(1) The modules are optional modules approved by the United States Department of Transportation, or its successor as specified above, and the optional modules are prescribed by rule by the board pursuant to the Alabama Administrative Procedure Act.

(2) The modules, though not included in the federally approved curriculum for a particular level of training, have been required in Alabama for emergency medical technician training at that level on or before January 1, 1995.

(3) The modules are necessary to train EMTs in the use of new procedures, devices, techniques, or drugs which may be approved by the board for use by EMTs.

(c) No ground ambulance and no convalescent ambulance shall be operated for ambulance purposes and no individual shall drive, operate, attend or permit same to be operated for the purpose of transporting a patient from any point within the State of Alabama to any other point within the State of Alabama unless such ambulance or convalescent ambulance is duly licensed by the Board of Health and unless it shall be under the immediate supervision and direction of a person who is holding a currently valid license as an emergency medical technician or as a physician. The Board of Health may prescribe exceptions to this requirement consistent with the interests of public health. Any ground ambulance or convalescent ambulance shall at all times be driven by a person holding a current, valid license as an ambulance driver.

The board shall be assisted in formulating rules and policy pertaining to emergency medical services by the State Emergency Medical Control Committee (SEMCC). Members of the SEMCC shall serve without compensation but shall be entitled to reimbursement for expenses incurred in the performance of the duties of their office at the same rate paid state employees. The chair of SEMCC may establish subcommittees of SEMCC comprised of representatives from ambulance, fire, rescue, and other EMS groups, as needed. The SEMCC shall be composed as follows:

(1) The medical directors of each regional EMS agency designated by the board.

(2) One member who shall be appointed by the Alabama Chapter of the American College of Emergency Physicians.

(3) One member who shall be appointed by the State Committee on Trauma of the American College of Surgeons.

(4) One member who shall be appointed by the Alabama Chapter of the American Academy of Pediatrics.

(5) The State EMS Medical Director, who shall serve as its chair.

(6) The State Trauma Consultant if a physician is designated as such by the Board of Health or pursuant to other procedure established by law.

(a) The board may by rule designate certain procedures as 'advanced life support techniques,' which may be performed by EMTs during emergencies, such as situations where the life, health, or safety of a prehospital patient is in immediate jeopardy. The board may prescribe by rule the qualifications and certification necessary for personnel performing advanced life support techniques, and the specific conditions under which the techniques may be performed by emergency medical technicians. Notwithstanding any statutory provision to the contrary, emergency medical services personnel who possess the necessary qualifications and certification prescribed by the board shall not be deemed to have engaged in the unlawful practice of medicine when performing advanced life support techniques in accordance with the constraints established by the board.

(b) Emergency vehicles manned by licensed emergency medical technicians who are trained to provide advanced life support and who possess current board licensure, may carry a drug kit containing limited quantities of drugs, including controlled substances, which have been approved by the board for administration to patients during the regular course of duties of prehospital personnel, provided, that these drugs may be administered only pursuant to the order of a physician who possesses a valid license to practice medicine within this state, and who is, at the time the order is given, functioning in accordance with the applicable regional medical control plan approved by the board. Fluids and drugs may not be carried by any ambulance service operator or other emergency medical services provider without a certificate of fluid and drug authorization from the board. The board may offer a certificate of fluid and drug authorization to a non-transport service which is not licensed if the unlicensed non-transport service meets all requirements in the board's rules for issuance of a certificate to a licensed ambulance operator.

(c) Emergency medical technicians may not perform services pursuant to standing orders from physicians without prior approval of the board. Emergency medical technicians may accept orders to perform advanced life support techniques only from medical control physicians who have completed medical control training prescribed by the board on the recommendation of the SEMCC and the State Health Officer.

This chapter shall govern and it shall authorize the Board of Health to regulate only emergency medical care provided outside of hospitals, emergency medical technicians who provide care outside of hospitals, ambulance drivers, ambulance service operators, ground ambulances, convalescent ambulances, the training of ambulance drivers and emergency medical technicians who provide care outside of hospitals, and orders given for emergency medical care to be provided outside of hospitals. To the extent medical care and nursing care provided within hospitals is governed by other provisions of law, these provisions of law shall not be construed to have been repealed, amended, abridged, or otherwise altered by this chapter.

In carrying out its duties and responsibilities under this chapter, the board shall follow the Administrative Procedure Act.

Neither the provisions of this chapter nor rules of the board adopted thereunder shall apply to volunteer fire departments which are not regularly engaged in the provision of emergency medical care and which offer only Basic Life Support response and do not transport. Volunteer fire departments which regularly provide emergency medical care shall be subject to this chapter, except when entitled to an exemption pursuant to Section 22-18-2. Provided, however, that this chapter and regulations adopted thereunder shall govern only the EMS functions of volunteer fire departments and shall not apply to their firefighting functions or other functions. A volunteer fire department shall have in place a system for the emergency treatment or transport of motor vehicle crash victims, or other trauma victims or emergency patients to be deemed to be regularly engaged in the provision of emergency medical care. A volunteer fire department which merely offers cardiopulmonary resuscitation and other first aid and rescue in the course of firefighting and related operations shall not be deemed for that reason alone to be regularly engaged in the provision of emergency medical care.

(a) There shall be an advisory board of 25 members to assist in the establishment of rules, regulations and standards necessary to carry out the provisions of this chapter. The board shall meet at least once each year and at the call of the State Health Officer. The State Health Officer shall be an ex officio member of the advisory board. The advisory board shall elect one from its membership to serve as chair for a two-year term. The chair shall not serve consecutive terms.

(b) Composition of the advisory board shall be:

(1) One member designated by the Alabama Ambulance Association.

(2) One member designated by the Alabama Association of Rescue Squads.

(3) One member designated by the Alabama Hospital Association.

(4) One member designated by the State Committee on Trauma, American College of Surgeons.

(5) One member designated by the Medical Association of the State of Alabama.

(6) One member designated by the Director of Public Safety.

(7) One member designated by the Director of the State Department of Transportation.

(8) One member designated by the Department of Economic and Community Affairs, Highway Traffic and Safety Program.

(9) State Health Officer, as ex officio member with voting privileges.

(10) One member who shall be a paramedic firefighter designated by the Professional Firefighters Association of Alabama.

(11) One member who shall be an EMT firefighter designated by the Alabama Association of Volunteer Fire Departments.

(12) One member designated by the Alabama Association of Fire Chiefs.

(13) Two members designated by the Alabama Council on EMS to represent the designated regional EMS agencies.

(14) One member designated by the State Committee of Public Health.

(15) One member designated by the Alabama Chapter of the American College of Emergency Physicians.

(16) One member designated by the Alabama Chapter of the American Academy of Pediatrics.

(17) One member from a state approved paramedic training school designated by the Alabama Emergency Medical Services Education Committee.

(18) One member who shall be an EMT designated by the professional EMT association if a professional EMT association is designated by the Board of Health or pursuant to other procedure established by law.

(19) One member designated by the Alabama Chapter of the Emergency Nurses Association.

(20) One member designated by the Alabama League of Municipalities.

(21) One member designated by the Association of County Commissions of Alabama.

(22) One member designated by the Alabama Emergency Management Council.

(23) One member designated by the Alabama State Nurses' Association.

(24) One member designated by the Alabama Firefighters Association.

(25) One member designated by the Alabama Society of Hospital Pharmacists.

(c) Each representative shall serve for a period of four years or until his successor is appointed, whichever is sooner.

(d) Each ex officio member's term will be indefinite. In the case of vacancy, the new appointee shall serve for the remainder of the unexpired term. Any vacancy shall be filled by the original organization selecting said member. Members of the advisory board shall serve without compensation but shall be entitled to reimbursement for expenses incurred in the performance of the duties of their office as provided in Article 2 of Chapter 7 of Title 36 of this Code.

(e) With the consent of the majority of the members of the advisory board, the chair shall set requirements for proxy representation, voting, and the establishment of a quorum.

(a) It shall be a Class A misdemeanor for any person, firm, company, corporation, organization, facility, or agency to do any of the following:

(1) Deliberately hinder, obstruct, or interfere with an officer, inspector, or duly authorized agent of the board while in the performance of official duties.

(2) Deliberately hinder, obstruct, or interfere with any physician, licensed nurse, licensed emergency personnel, or emergency personnel exempt from licensure under the provisions of this chapter while that person is providing emergency care to a third person or while that person is assisting at the scene of an emergency, directing traffic at the scene of an emergency, or managing or helping to manage the scene of an emergency.

(3) Violate subsections (c) or (d) of this section.

(4) Offer, provide, or perform, without a valid, current license or certificate to do so, an emergency medical service or other function which, under the provisions of this chapter or the rules adopted pursuant thereto, may not be performed without a license or certificate issued by the Board of Health. No person shall be subject to criminal liability pursuant to this section in the event he or she renders first aid or emergency care at the scene of an injury caused by a motor vehicle crash or by some other incident, or at the scene of a mass casualty or disaster if:

a. The first aid or emergency care is rendered gratuitously and in good faith; and

b. The first aid or emergency care is not rendered in the course of a business, program, or system which regularly engages in the provision of emergency medical care.

(b) Nothing in this subsection shall be construed to repeal, abridge, or modify Section 6-5-332 or any other good Samaritan statute.

(c) No person shall regularly engage in providing emergency medical care at the scene of emergencies unless he or she is a licensed emergency medical technician as defined in this chapter, or unless he or she is exempted from licensure pursuant to the provisions of this chapter. Notwithstanding the foregoing, nothing in this chapter shall be construed to prohibit any physician or nurse licensed in Alabama from performing any act within his or her scope of practice. No person shall hold himself or herself out to be an emergency medical technician unless he or she is a licensed emergency medical technician as defined in this chapter. Provided, that emergency medical technicians licensed in other jurisdictions may identify themselves as holding such licensure.

(d) The board shall by rule establish the scope of privilege for each level of emergency medical technician licensure. No person shall exceed the scope of privilege granted to his or her level of licensure.

(e) Control of an emergency scene may be taken by an emergency medical technician or other emergency personnel if the personnel arrive at the scene of an emergency prior to the arrival of law enforcement personnel, and if managing the emergency scene will not interfere with other emergency medical care duties. Emergency scene control shall include the authority to direct traffic. A driver of a motor vehicle entering an emergency scene or entering a roadway adjacent to an emergency scene shall use caution, shall maintain proper control of the motor vehicle, and shall obey the directions of law enforcement personnel and emergency personnel at the scene. Any person violating this subsection shall be guilty of a violation.

(f) The board may, following the contested case provisions of the Administrative Procedure Act, suspend or revoke the license or certificate of an ambulance driver, an emergency medical technician at any level, or an ambulance service operator, or it may refuse to grant a license or certificate to any person or entity at any time that any of the following is determined with respect to the holder or applicant:

(1) Does not meet or no longer meets the prescribed qualifications.

(2) Is guilty of misconduct as defined by the board's rules or otherwise commits a violation of this act or any rules promulgated thereunder.

(3) Has failed to maintain the required level of continuing education units or any equivalent therefor defined in the board's rules.

(4) Has provided care to a patient or patients under his or her care which falls short of the standard of care which ordinarily would be expected to be provided by similarly situated EMS personnel in Alabama, and has thereby jeopardized the life, health, or safety of a patient or patients.

(5) Has sexually or physically abused a patient under his or her care.

(6) Has submitted a license or test application, a report of continuing education requirements, a run report, a patient care record, EMT student record, clinical rotation record, intent to train form, self-study document, fluid and drug application, physician medication order form, or any other document which is material to the duties and qualifications of EMS personnel or those of a student in an EMT training program and which is fraudulent or knowingly false in any respect.

(7) Has committed fraud in the performance of his or her duties or in connection with any matter related to emergency medical services.

(8) Has been convicted of a crime involving moral turpitude, or a crime in which the victim is an EMS provider organization or an EMS patient, unless the board determines that the fact of the conviction would not be likely to interfere with the performance of EMS duties.

(9) Has performed any act requiring licensure or certification under state EMS statutes, without possession of the requisite licensure or certification.

(10) Has performed any act which exceeds the scope of license or privilege granted to the holder.

This chapter is cumulative and shall not be construed as limiting any power or authority of any municipality to set standards equal to, or above, state standards as provided in this chapter.

In those instances in which an ambulance service operator, ambulance driver, ambulance attendant, ambulance driver-attendant, or emergency medical technician of any municipality, county, fire district, or the state is employed by the State of Alabama, any county, fire district, or another municipality, within 24 months after completing the training requirements mandated by this chapter, or by rules adopted by the Alabama Committee on Public Health, the total expense of the training, including, but not limited to, salary paid during training, transportation costs paid to the trainee for travel to and from the training facility, room, board, tuition, overtime paid to other employees who fill in for the trainee during his or her absence, and any other related training expenses, shall be reimbursed to the municipality, county, fire district, or the state which paid for the training. The municipality, county, fire district, or the state which paid for the training shall submit an itemized sworn statement to the new employer of the ambulance service operator, ambulance driver, ambulance attendant, ambulance driver-attendant, or emergency medical technician, as the case may be, shall demand payment thereof, and may enforce collection of the obligation through civil remedies and procedures. The terms 'ambulance service operator,' 'ambulance driver,' 'ambulance attendant,' 'ambulance driver-attendant,' and 'emergency medical technician,' shall have the same meanings as in Section 22-18-1.